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Regional  Oral  History  Office  University  of  California 

The  Bancroft  Library  Berkeley,  California 


Frank  Leven  Albert  Gerbode 

FRANK  LEVEN  ALBERT  GERBODE: 
PIONEER  CARDIOVASCULAR  SURGEON 


With  an  Introduction  by 
Norman  E.  Shumway,  M.D. 


An  Interview  Conducted  by 
Sally  Smith  Hughes 
1983-1984 


Copyright  (c)  1985  by  The  Regents  of  the  University  of  California 


All  uses  of  this  manuscript  are  covered  by  a.  legal 
agreement  between  the  University  of  California  and 
Frank  Leven  Albert  Gerbode  dated  November  8,  1983.   The 
manuscript  is  thereby  made  available  for  research  purposes , 
All  literary  rights  in  the  manuscript,  including  the 
right  to  publish,  are  reserved  to  The  Bancroft  Library 
of  the  University  of  California  at  Berkeley.  No  part  of 
the  manuscript  may  be  quoted  for  publication  without  the 
written  permission  of  the  Director  of  The  Bancroft  Library 
of  the  University  of  California  at  Berkeley. 

Requests  for  permission  to  quote  for  publication 
should  be  addressed  to  the  Regional  Oral  History  Office, 
486  Library,  and  should  include  identification  of  the 
specific  passages  to  be  quoted,  anticipated  use  of  the 
passages,  and  identification  of  the  user. 

It  is  recommended  that  this  oral  history  be  cited 
as  follows : 

Frank  Leven  Albert  Gerbode,  "Frank  Leven  Albert 
Gerbode:   Pioneer  Cardiovascular  Surgeon,"  an  oral 
history  conducted  1983-1984  by  Sally  Smith  Hughes, 
Regional  Oral  History  Office,  The  Bancroft  Library, 
University  of  California,  Berkeley,  1985. 


Copy  No . 


1 


FRANK  LEVEN  ALBERT  GERBODE 
1907  -  1984 


Underwritten  by  the  Gerbode  children 
in  memory  of  their  father. 


TABLE  OF  CONTENTS  —  Frank  Gerbode 

INTRODUCTION  by  Norman  E.  Shumway,  M.D.  i 

INTERVIEW  HISTORY  ill 

I   FAMILY  BACKGROUND,  EDUCATION  AND  EARLY  CAREER  1 

Grandparents,  Parents,  Brother  and  Sisters  1 

Grammar  and  High  School  Education  4 

Undergraduate  Education  at  Stanford  4 

The  Decision  to  Go  into  Medicine  5 

Extracurricular  Activities  at  Stanford  6 

Financing  the  Stanford  Tuition  6 

The  Major  in  Physiology  7 

The  Decision  to  Become  a  Surgeon  9 

The  Stanford  Medical  Curriculum  in  the  1930s  10 

Research  in  Medical  School  11 

Emile  Holman,  Surgeon  12 

F.L.  Reichert,  Neurosurgeon  14 

Cardiovascular  Surgery  before  World  War  I  15 

Marriage  16 

Internship  at  Highland  Hospital,  1935-1936  18 

Assistant  in  Pathology  at  the  University  of  Munich,  1936-1937  20 

Hans  Borst  23 

Surgical  Resident  and  Instructor  in  Surgery  at  Stanford,  1937-1942  27 

Early  Cardiovascular  Surgery  29 

Prewar  Cardiovascular  Research  31 

Premonitions  of  World  War  II  33 

II   SURGEON,  U.S.  ARMY  MEDICAL  CORPS,  1942-1945  35 

Decision  to  Go  to  War  35 

Preparations  in  the  U.S.  36 

Casablanca  38 

Andrew  Peatroscka  40 

Palermo,  Sicily  41 

Anzio  43 

Wound  Treatment  45 

Salerno  and  Southern  France  46 

The  Story  of  Carpentras  47 

Field,  Mobile  and  Base  Hospitals  49 

The  German  Retreat  to  the  Vosges  Mountains  50 

Wartime  Surgery  51 


Heidelberg  52 

Mutzig  53 

The  Battle  of  the  Bulge  54 

Wartime  Surgery  (Continued)  54 

The  German  Wounded  58 

Booby  Traps  and  Mines  59 

Pushing  Back  the  Germans  59 

Dachau  60 

Munich  61 

The  German  Surrender  62 

Return  to  the  United  States  64 

Dwight  Barken  65 

Combat  Medals  66 

Other  Base  Hospital  Units  67 

The  Commanding  Officer  68 

Correspondence  to  and  from  Home  69 

III  THE  IMMEDIATE  POSTWAR  YEARS  70 

Research  and  Surgery  70 

Decision  to  Stay  at  Stanford  70 

Simulated  Congenital  Lesions  and  Extracorporeal  Circulation  71 

Patient  Referrals  72 

Early  Vascular  and  Heart  Surgery  in  the  United  States  74 

Robert  Gross:  Operations  for  Patent  Ductus  and  Coarctation  75 

The  Blalock  Procedure  75 

Factors  in  the  Advance  of  Thoracic  Surgery  77 

Endotracheal  Anesthesia  77 

The  Engstrom  Volume  Respirator  78 

Advances  Affecting  Cardiovascular  Surgery  80 

Cardiac  Catheterization  80 

Rapid  Xray  Film  Changers  83 

Blood  Transfusion  85 

Penicillin  86 

Drugs  Regulating  Blood  Coagulation  87 

Visiting  Professor  at  St.  Bartholomew's  Hospital,  London,  1949-1950  89 

Frank  Rundle,  George  Ellis  and  Emmanuel  Amoroso  89 

Dog  Surgeon  91 

Honorary  Perpetual  Student  93 

American  and  British  Postwar  Surgery:  A  Comparison  94 

Cardiovascular  Surgery  97 

Hypothermia  98 

Vascular  Anastomoses  to  the  Heart  99 


IV  THE  DEVELOPMENT  OF  CARDIOVASCULAR  SURGERY  101 

The  1983  California  State  Bill  on  Animal  Experimentation  101 

Oxygenators,  Hypothermia  and  Open  Heart  Surgery  101 

John  and  Maly  Gibbon:   The  First  Heart-Lung  Machine  102 

John  Kirklin  and  the  Gibbon  Heart-Lung  Machine  103 

The  DeWall  Bubble  Oxygenator  103 

George  Clowes  and  the  Membrane  Oxygenator  104 

The  Bramson  Membrane  Oxygenator  104 

Hypothermia  (Continued)  107 

Teamwork  109 

M.L.  Bramson  and  the  Membrane  Oxygenator  110 

Industrial  Development  of  the  Membrane  Oxygenator  111 

The  Disk  Oxygenator  113 

Pump  Technicians  115 

The  American  Society  for  Artificial  Organs  116 

Pumps  117 

Dennis  Melrose's  Heart-Lung  Machine  118 

Patient  Response  119 

Patient  Selection  120 

Cardiologists  120 

Mitral  Valvotomy  122 

The  Crippled  Children's  Services  125 

Funding  for  Cardiovascular  Research  127 

Mitral  Stenosis:   Operative  Procedures  128 

Communication  Among  Surgeons  129 

Mitral  Stenosis:   Operative  Procedures  (Continued)  130 

Mitral  Stenosis:   Patient  Selection  132 

Heart  Valve  Replacement  133 

The  Korean  War  and  Its  Aftermath  138 

Service  as  a  Brigadier  General  138 

John  Howard:   Blood  Replacement  141 

Frank  Spencer:   Early  Repair  of  Blood  Vessels  in  the  Field  142 

Vascular  Suture  142 

Vein  Grafts  143 

Heart  Transplantation  146 

The  Problem  of  Rejection  146 

Norman  Shumway  147 

Fallout  from  Surgical  Advances  148 

Consultant  Positions  149 

Oak  Knoll  Naval  Hospital,  Oakland  149 

Letterman  General  Hospital,  San  Francisco  149 

Positions  in  Washington,  D.C.  150 


PRESBYTERIAN  MEDICAL  CENTER,  THE  HEART  RESEARCH  INSTITUTE,  AND 

COMPUTERIZED  PATIENT  MONITORING  153 

The  Stanford  Medical  School's  Move  to  Palo  Alto,  1959  153 

Debate  Over  the  Move  153 

Decision  to  Stay  in  San  Francisco  154 

Attempts  to  Retain  a  Connection  with  Stanford  155 

Staff  Decisions  about  the  Move  157 

The  Institutes  of  Medical  Sciences  159 

Foundation  160 

The  NIH  Program  Project  Grant  161 

The  Heart  Research  Institute  Fellowship  Program  in 

Cardiovascular  Surgery  163 

Presbyterian  Hospital  166 

The  Presbyterian  Church  167 

St.  Joseph's  Hospital  167 

The  University  of  the  Pacific  168 

The  Bank  of  America  169 

Designing  the  New  Presbyterian  Hospital  169 

Computerized  Patient  Monitoring  171 

IBM  171 

Hewlett-Packard  174 

Research  Programs  at  the  Heart  Research  Institute  175 

Postoperative  Problems  after  Open  Heart  Surgery  175 

The  Bramson  Membrane  Oxygenator  176 

Heart-Lung  Machines  Elsewhere  176 

Platelets  177 

The  Institutes  of  Medical  Sciences  (Continued)  178 

Administration  180 

Research  182 

Commercialization  182 

Administrative  Policy  183 

The  Peer  Review  System  184 

The  Institutes  of  Medical  Sciences  (Continued)  186 

Teaching  and  Training  Programs  186 

Reasons  for  Establishing  a  Medical  Research  Institution  188 

Ph.D.s  and  M.D.s  190 

Founding  New  Institutes  191 

Sharing  Equipment  and  Facilities  192 

Accomplishments  and  Reputation  193 

The  Decision  to  Do  Heart  Transplantations  at  Pacific  Medical  Center    194 

Ethical  and  Psychological  Considerations  in  Medicine  196 

Computerized  Patient  Monitoring  (Continued)  198 


VI   MEDICAL /SURGICAL  ACTIVITIES  AND  HONORS  201 

The  Frank  Gerbode  Medical  Research  Foundation  201 

Professional  Societies  and  Associations  202 

The  American  Association  for  Thoracic  Surgery  202 

The  Society  of  Thoracic  Surgeons  203 

The  American  Surgical  Association  203 

The  Society  of  University  Surgeons  204 

The  Society  of  Clinical  Surgery  205 

Presidency  of  the  American  Association  for  Thoracic  Surgery  205 

The  Bay  Area  Vascular  Society         *  206 

The  International  Surgical  Society  207 

Surgery  in  Various  Countries:   Comparisons  212 

The  Pan-Pacific  Surgical  Association  214 

The  Society  for  Vascular  Surgery  215 

The  International  Cardiovascular  Society  215 

The  American  Heart  Association  216 

The  California  Academy  of  Medicine  217 

Honors  218 
Master  of  Surgery  (Honoris  Causa)  ,  the  National  University  of 

Ireland,  1961  219 

M.D.  (Honoris  Causa),  Uppsala  University,  1965  219 
Honorary  Fellow  of  the  Royal  College  of  Surgeons  of  England 

and  Edinburgh,  1969  and  1975  220 

M.D.  (Honoris  Causa),  University  of  Thessaloniki,  1964  220 

The  Rene  Leriche  Prize,  International  Society  of  Surgery,  1973     221 

Alexis  Carrel  221 
The  British  Order  of  St.  John  of  Jersualem,  1956;  Knight,  1978     222 

Service  on  Editorial  Boards  224 

Affiliations  with  Medical  Institutions  in  the  Bay  Area  227 

Children's  Hospital,  San  Francisco  227 

Oak  Knoll  Naval  Hospital,  Oakland  227 

The  University  of  California,  San  Francisco  228 

The  California  State  Board  of  Health  236 

Visiting  Professorships  236 

St.  Bartholomew's  Hospital,  London,  1949  237 

The  Royal  North  Shore  Hospital,  Melbourne,  1953  237 

The  Prince  Henry  Hospital,  Sydney,  1963  238 

St.  Thomas'  Hospital,  London,  1958  240 

The  Free  University  of  Berlin,  1960  241 

The  University  of  Heidelberg,  1964  242 

The  Karolinska  Hospital,  Stockholm,  1964  243 

Duke  University,  Durham,  North  Carolina,  1973  245 

The  University  of  Alberta  at  Edmonton,  1974  246 


VII  COMMENTS  ON  MEDICAL /SURGICAL  TOPICS  248 
More  on  Research  in  the  Surgical  Laboratory  of  the  Old  Stanford 

Medical  School  248 

Experimentally- induced  Cyanosis  249 

The  Heart-Lung  Machine  250 

Norman  Shumway:   Cold  Arrest  of  the  Heart  and  Heart  Transplantation  251 

Dieners  254 

The  Artificial  Heart  255 

Targeted  vs.  Basic  Research  257 

Legal  and  Ethical  Aspects  of  Medicine  258 

The  Legal  Aspect  258 

The  Ethical  Aspect  259 

Malpractice  Suits  260 

The  Legal  Aspect  (Continued)  261 

Medical  Ethics  Committees  262 

Research  Versus  Patient  Benefit  263 

The  Doctor-Patient  Relationship  265 

Patient  Referral  265 

Medical  Uncertainty  266 

New  Diagnostic  Techniques  in  Cardiology  266 

Teaching  268 

VIII  PHILANTHROPY,  FAMILY  AND  RECREATION  269 

The  Wallace  Alexander  Gerbode  Foundation  269 

Religion  280 

Martha  Alexander  Gerbode  281 

Family  Life  288 

The  Chit  Chat  Club  290 

The  Home  on  Divisadero  Street  294 

Children  297 

Wallace  Alexander  Gerbode  297 

Susan  Gerbode  298 

Wallace  Alexander  Gerbode  (Continued)  298 

Maryanna  Gerbode  Shaw  298 

Frank  Albert  Gerbode  III  300 

The  Adoption  302 

John  Philip  Gerbode  303 

Property  on  Kauai  304 

Hobbies  305 

Tennis  306 

Carpentry  306 

Photography  306 

Painting  307 

Sailing  308 

A  Brush  with  McCarthyisra  310 


IX  TRIPS  314 

Russia  314 

China 

Saudi  Arabia 
Australia  335 

X   FURTHER  COMMENTS  ON  MEDICAL  /SURGICAL  TOPICS  338 

NIH  Support  of  the  Multidisciplinary  Team  in  Cardiovascular 

Surgery  338 

The  Artificial  Heart  Program  341 

Targeted  Medical  Research  342 

The  Transventricular  Mitral  Valve  Dilator  344 

The  First  Open  Heart  Surgery  Team  on  the  West  Coast  345 

Endocardial  Cushion  Defects  348 

The  Membrane  Oxygenator  349 

Counseling  Patients 
Aortocoronary  Bypass  Operations 

Keeping  Patients  Alive  at  Any  Cost  353 

Heart  Transplantation  Programs  354 

Etiology  357 

Setting  and  Controlling  Medical  and  Surgical  Fees  358 

Artificial  Heart  Valves 

Extrapolation  from  Animal  Research  to  Operations  on  Humans  365 

Consent  Forms 
Correcting  Septal  Defects 
Early  Open  Heart  Operations 

Postoperative  Problems  after  Open  Heart  Surgery 
An  Aortic  Valve  Prosthesis 
The  Early  Membrane  Oxygenator 

The  Bubble  Oxygenator  375 

Early  Extracorporeal  Research  377 

XT  PACIFIC  MEDICAL  CENTER  AND  ITS  PREDECESSORS 

The  Institutes  of  Medical  Sciences  and  the  Old  Presbyterian  Hospital 

The  Institutes 

The  Old  Stanford  Hospital  and  the  Presbyterian  Church  ->87 

Proposal  for  a  Medical  School  390 

Free  Hospital  Beds  395 

Mergers  with  Other  Hospitals  397 

The  New  Presbyterian  Hospital  398 

The  Heart  Research  Institute  Fellowship  Program 

Frank  Rundle  *®° 

John  Callaghan 

Dennis  Melrose 


Mark  Bainbridge 

Gutmund  Semb 

The  Evarts  Graham  Fellowship 

AM  7 

Torkel  Aberg 
The  Accomplishments  of  the  Medical  Research  Institute 


XII  MISCELLANY  412 

Honors  412 
The  Second  Henry  Ford  International  Symposium  on  Cardiac  Surgery   412 

Shiley ' s  Celebration  of  the  40th  Anniversary  of  Cardiac  Surgery  413 

The  Michael  E.  DeBakey  Award  414 

Communication  Among  Surgeons  415 

The  Bohemian  Club  416 

The  Tuberculosis  Hospital  in  San  Luis  Obispo  417 

Early  Surgical  Lists  420 

A  Letter  to  John  Kinmouth,  January  1957  424 

A  Letter  from  John  Kinmouth,  January  1959  425 

A  Letter  to  John  Kinmouth,  April  1959  426 

A  Case  Report  from  Letterman  General  Hospital,  February  1960  427 

A  Letter  to  Viking  BjiJrk,  May  1960  428 

The  Look  Magazine  Article,  1963  428 

A  Letter  from  John  Kinmouth,  September  1960  431 

Fritz  Linder  and  the  University  of  Heidelberg  432 

A  Contract  to  Retrain  Female  Physicians  433 
A  Contract  to  Develop  a  Computer  System  to  Identify  Vacant 

Hospital  Beds  434 

A  Grant  for  a  Training  Program  in  Cardiovascular  Surgery  434 
More  on  the  Possibility  of  a  Medical  School  at  Presbyterian 

Medical  Center  435 

Arthur  Selzer,  Ian  Carr  and  Pediatric  Cardiology  436 

A  Letter  to  Hans  Borst,  September  1971  437 

Operating  Room  Donors  at  the  New  Presbyterian  Hospital  438 

A  Letter  from  Hans  Borst,  January,  1955  439 

Grants  to  Establish  Cardiovascular  Centers  439 

Heart  Clinics  in  Alaska  440 

Surgical  Films  444 

Malpractice  445 

The  Salgo  Case,  1957  446 

Consent  Forms  451 

The  Captain  of  the  Ship  Doctrine  452 

The  University  of  California  and  the  Salgo  Case  454 

Expert  Witnesses  454 

Pre-  and  Postoperative  Consultations  456 

Malpractice  Insurance  in  California  457 

The  California  Medical  Association  and  Medical  Liability  457 


XIII   FURTHER  COMMENTS  ON  EARLIER  TOPICS  459 

Recent  Problems  at  the  Medical  Research  Institute  459 
Possible  Affiliation  of  Pacific  Medical  Center  and  Children's 

Hospital  462 

Recent  Problems  (Continued)  463 

Heart  Transplantation  468 

Family  Background  and  Early  Education  470 

Surgical  and  Medical  Societies  477 
The  American  College  of  Surgeons  and  the  American 

Surgical  Society  477 
The  International  College  of  Surgeons  and  the  International 

Society  of  Surgery  477 

The  International  Cardiovascular  Society  481 

The  Society  of  University  Surgeons  483 

The  Postwar  Growth  of  Cardiovascular  Surgery  484 

The  Fellowship  Program  in  Cardiovascular  Surgery  484 

A  Letter  to  Costas  Tountas,  1974  486 

A  Letter  from  Norman  Shumway,  December  1976  486 

TAPE  GUIDE  488 

APPENDICES  490 

INDEX  533 


INTRODUCTION 


Frank  Gerbode  was  a  man  of  many  parts.   Fortunately,  these  transcripts 
reveal  some  of  the  facets  that  made  Frank  Gerbode  a  household  name  everywhere 
there  is  any  surgery  of  the  heart.   In  1954  after  years  of  careful  research 
Dr.  Gerbode  performed  the  first  successful  open  heart  surgical  procedure  in 
the  western  United  States.   In  1958  an  actual  open  heart  surgical  procedure 
was  televised  live  from  the  old  Stanford  Hospital  in  San  Francisco.   An  atrial 
septal  defect  was  found  to  have  anomalous  pulmonary  venous  drainage  so  a 
more  complicated  surgical  procedure  was  carried  out  than  was  originally  planned. 
The  patient  made  an  uneventful  recovery,  and  a  wide  public  audience  began  to 
realize  the  potential  of  this  new  approach  to  previously  hopeless  cardiac 
diseases.   Working  first  with  the  ingenious  Dr.  John  Osborn,  then  with  the 
dynamic  Dennis  Melrose  of  the  United  Kingdom,  Dr.  Gerbode  developed  a  safe  and 
reliable  heart-lung  machine  to  maintain  the  patient  during  open  heart  surgery. 
Dr.  Gerbode  was  among  the  first  to  appreciate  the  importance  of  a  versatile 
and  loyal  laboratory  staff.   Bing  Moy  and  Don  Toy  were  of  outstanding  help  in 
the  early  days  of  the  open  heart,  and  they  reflected  Dr.  Gerbode 's  admiration 
and  confidence. 

Dr.  Frank  Gerbode  was  a  meticulous  and  outstanding  cardiac  surgeon.   He 
was  the  first  to  suggest  the  median  sternotomy  for  all  kinds  of  cardiac  surgery. 
Prior  to  his  use  of  this  approach,  the  bilateral  tranverse  sternotomy  was 
universally  utilized.   The  number  of  postoperative  complications  incidental  to 
the  bilateral  thoracotomy  was  greatly  reduced.   Dr.  Gerbode  reported  the  first 
series  of  left  ventricular-right  atrial  shunts  and  their  successful  closure. 
In  the  very  important  area  of  postoperative  care  for  the  open  heart  surgical 
patient,  Frank  Gerbode  was  at  the  vanguard  of  those  who  computerized  the 
various  physiological  parameters  so  important  in  that  crucial  period  of 
convalescence . 

Outside  of  the  operating  room,  Frank  Gerbode  was  a  most  generous  individual. 
Colleagues  from  all  over  the  world  were  welcome  in  his  beautiful  home,  and  he 
liked  nothing  better  than  to  take  them  out  in  his  sailboat  for  a  day  on 
San  Francisco  Bay.   Having  trained  upwards  of  200  cardiac  surgeons  worldwide, 
Dr.  Gerbode  never  needed  to  find  hotel  accommodations  wherever  he  travelled. 
He  was  the  father  figure  for  many  younger  cardiac  surgeons  and  physicians. 

Frank  Gerbode  brought  much  worldwide  attention  to  Stanford  University. 
As  it  is  said,  however,  a  prophet  is  never  without  honor  except  in  his  own  home 
town.   With  the  retirement  in  1955  of  Emile  Holman  from  the  chair  of  surgery 
at  Stanford,  the  obvious  choice  of  Frank  Gerbode  to  be  the  successor  was  not 
forthcoming.   The  Pacific  Coast  Surgical  Association,  for  which  Frank  Gerbode 


ii 


had  often  been  the  host  when  that  group  would  meet  in  Hawaii,  likewise  failed 
the  opportunity  to  appreciate  Dr.  Gerbode  by  making  him  its  president.   Neither 
of  these  slights  seemed  ever  to  bother  Frank  Gerbode,  but  it  is  interesting 
to  speculate  what  might  have  happened  to  clinical  medicine  at  Stanford  if 
Frank  Gerbode  had  been  chairman  of  the  department  of  surgery  when  the  medical 
school  moved  to  Palo  Alto. 

Staying  in  San  Francisco  and  almost  single-handedly  building  a  new 
medical  center  to  become  known  as  the  Presbyterian  Hospital  and  the  Pacific 
Medical  Center,  Frank  Gerbode  continued  to  perform  and  support  significant 
research  as  well  as  developing  in  a  private  hospital  environment  a  most 
respectable  educational  program.  National  and  international  honors  compensated 
for  the  lack  of  local  recognition  and  appreciation  given  to  Frank  Gerbode. 
He  was  an  honorary  member  of  the  Royal  College  of  Surgeons  of  England  and 
Edinburgh.   He  was  president  of  the  American  Association  for  Thoracic  Surgery. 
In  1982  he  was  the  first  recipient  of  the  Michael  E.  DeBakey  Award  for 
Excellence  in  Cardiac  Surgery. 

All-in-all,  Frank  Gerbode  was  a  man  of  tremendous  quality.   Everything 
he  did  had  the  touch  of  excellence  about  it.   Like  the  late  Henry  Kaplan,  the 
renowned  radiotherapist  and  conqueror  of  Hodgkin's  disease,  Frank  Gerbode 
would  tolerate  only  the  highest  quality  work. 

Frank  Gerbode  had  his  off  days.   As  Somerset  Maugham  once  said,  "Only  a 
mediocre  man  is  always  at  his  best."  But  on  his  best  days,  and  Frank  Gerbode 
was  usually  at  his  best,  he  had  mighty  few  peers.   As  Frank  would  say,  "Life 
goes  on,"  so  it  is  left  for  the  rost  of  us  to  do  our  best  and  hope  that  its 
performance  will  come  close  to  the  standard  that  he  established  for  us. 


Norman  E.  Shumway,  M.D. 


29  April  1985 

Department  of  Cardiovascular  Surgery 

Stanford  University 

Palo  Alto,  California 


iii 


INTERVIEW  HISTORY 


Frank  Leven  Albert  Gerbode  was  interviewed  by  the  Regional  Oral  History 
Office  to  document  his  professional  career  as  a  pioneer  of  cardiovascular 
surgery  and  to  record  other  aspects  of  his  many-sided  life.   Highlights  of 
the  medical  and  surgical  portions  of  the  interviews  include  his  contributions 
and  those  of  his  surgical  colleagues  to  the  explosive  growth  of  cardiovascular 
surgery  after  World  War  II,  his  development  with  M.L.  Bramson  of  a  membrane 
heart-lung  machine,  his  formation  and  leadership  of  the  first  open  heart 
surgery  team  on  the  West  Coast,  his  collaboration  with  John  J.  Osborn  in  the 
organization  of  a  computerized  monitoring  system  for  postoperative  patient 
care,  and  his  prominent  role  in  the  foundation  of  the  Institutes  of  Medical 
Sciences  (now  the  Medical  Research  Institute)  at  Pacific  Medical  Center,  San 
Francisco. 

Although  retired  from  surgery  since  1980,  Dr.  Gerbode  at  the  time  of  the 
interviews  was  anything  but  inactive.   He  was  director  of  the  Heart  Research 
Institute,  and  a  trustee  on  the  board  of  directors  of  both  MRI  and  the  Pacific 
Medical  Center.   He  was  an  active  member  of  numerous  surgical  societies,  and 
made  frequent  trips  to  attend  meetings  across  the  country  and  around  the 
world.   On  these  occasions  he  usually  encountered  some  of  the  former  fellows 
of  the  training  program  in  cardiovascular  surgery  which  he  founded  at  the 
Heart  Research  Institute.   Dr.  Gerbode  regarded  the  training  of  this  outstanding 
group  of  surgeons  as  his  greatest  professional  accomplishment. 

Dr.  Gerbode 's  international  renown  in  cardiovascular  surgery  appears  from 
his  account  in  the  interviews  to  have  been  due  to  a  combination  of  factors. 
He  returned  from  World  War  II  with  wide  surgical  and  organizational  experience. 
However,  like  many  other  American  surgeons  who  had  interrupted  their  careers 
to  go  to  war,  he  found  few  opportunities  to  operate  when  he  returned  home.   With 
time  on  his  hands,  he  turned  to  the  dog  lab  where  he  developed  operative  skills 
and  procedures  which  were  to  serve  him  well  when  surgical  cases  subsequently 
were  referred  to  him.   The  war  and  immediate  postwar  years  produced  the 
ingredients  for  the  rapid  growth  of  cardiovascular  surgery:   such  things  as 
antibiotics  to  control  postoperative  infection,  better  blood  typing  and  handling 
methods ,  improved  techniques  for  administering  anesthesia  with  an  open  chest , 
efficient  respirators,  and  the  first  primitive  heart-lung  machines. 

There  was  in  addition  a  conceptual  change.   The  prewar  notion  that  the 
heart  was  surgically  inviolate  had  been  proven  wrong  by  Dwight  Harken  and  other 
pioneers  of  heart  surgery.   Dr.  Gerbode,  well  trained  in  the  practice  of  surgery 
and  the  protocol  of  the  research  laboratory,  was  in  a  fine  position  to  take 
advantage  of  the  opportunities  in  the  promising  new  field  of  cardiovascular 
surgery. 


iv 


But  circumstance  and  timing  are  not  in  themselves  sufficient  to  explain 
Dr.  Gerbode's  professional  achievements.   First  and  foremost,  he  was  a  man  of 
diverse  abilities.   In  respect  to  surgery,  he  possessed  the  rigorous  education, 
manual  dexterity,  and  wide  surgical  experience  required  for  the  formation  of 
an  outstanding  surgeon.   In  addition  he  had  the  ability  to  attract  able  people 
as  his  collaborators  and  assistants.  His  successes  with  the  open  heart  surgery 
team,  the  surgical  fellows  training  program,  computerized  patient  monitoring, 
and  the  membrane  heart-lung  machine  are  testimony  to  this  ability.   He  also 
had  organizational  and  leadership  skills  and  what  he  called  a  logistical  sense 
which  permitted  him  to  keep  his  complex  professional  and  personal  affairs 
running  smoothly  and  productively.   Last  but  not  least,  he  had  vision,  a 
willingness  to  risk  the  unknown  and  untried,  and  the  personal  warmth  and  social 
and  financial  connections  to  win  support  for  his  ventures. 

In  addition  to  his  professional  concerns,  Dr.  Gerbode  had  many  philan 
thropic,  social,  and  artistic  interests.  He  was  a  trustee  of  the  Wallace  A. 
Gerbode  Foundation,  a  family  philanthropy  which  he  and  his  wife,  Martha  Alexander 
Gerbode,  established  in  memory  of  their  oldest  son.  After  the  death  of  Mrs. 
Gerbode  in  1971,  their  daughter,  Maryanna  Gerbode  Shaw,  and  son,  Frank  Albert 
Gerbode  III,  became  board  members. 

A  genial  and  sociable  man,  devoted  to  family  and  friends,  Dr.  Gerbode  was 
also  active  in  the  social  and  artistic  life  of  San  Francisco.   In  his  free 
time,  if  that  can  be  imagined,  he  enjoyed  sailing  on  San  Francisco  Bay,  skiing 
at  Sugar  Bowl,  duck  hunting  in  the  Sacramento  Valley,  visiting  his  farm  on  the 
island  of  Kauai,  and  painting  in  oils  and  acrylics. 

Dr.  Gerbode  was  a  tall  man,  distinguished  in  appearance,  with  glasse«,  a 
full  head  of  white  hair,  and  a  neat  mustache.  He  was  fond  of  clothes,  particu 
larly  ties,  and  was  always  impeccably  dressed.  One  was  struck  by  the  directness 
of  his  manner  and  gaze,  which  were  tempered  by  his  sense  of  humor,  ready 
chuckle,  and  infectious  love  of  life. 

Dr.  Gerbode  died  unexpectedly  on  December  6,  1984.  A  memorial  service, 
attended  by  family,  friends,  and  members  of  the  medical  and  civic  communities, 
was  held  at  Grace  Cathedral  on  December  14.  A  tape  recording  of  the  service  led 
by  Dr.  Gerbode's  friend,  the  Very  Reverend  C.  Julian  Bartlett,  Dean  Emeritus 
of  Grace  Cathedral,  is  on  file  in  The  Bancroft  Library. 


The  interviewer:   Sally  Smith  Hughes  is  an  interviewer  on  medical  and 
scientific  topics  for  the  Regional  Oral  History  Office.   She  has  degrees  in 
zoology  and  anatomy  from  the  University  of  California  and  a  Ph.D.  in  the 
history  of  medicine  from  the  University  of  London. 


Circumstances  of  the  interviews:   The  first  twelve  interviews  were 
conducted  between  July  20,  1983  and  October  23,  1983  in  Dr.  Gerbode's  office 
in  the  Medical  Research  Institute  at  2200  Webster  Street,  San  Francisco.   The 
office,  replete  with  medical  books  and  memorabilia,  included  a  couch  stacked 
with  current  journals  and  catalogs  which  he  was  in  the  process  of  reading. 
Over  his  desk  hung  a  collage  of  family  photographs  and  mementos,  including 
several  shots  of  his  sailboat. 

A  second  set  of  ten  interviews  was  conducted  between  April  12,  1984  and 
November  14,  1984  after  Dr.  Gerbode  and  the  interviewer  realized  that  several 
topics  had  inadvertently  been  omitted  from  the  earlier  sessions.   Many  of  the 
topics  were  suggested  by  reading  Dr.  Gerbode's  extensive  correspondence  which 
provides  an  insider's  account  of  the  growth  of  cardiovascular  surgery  on  the 
West  Coast.* 

The  second  series  of  interviews  were  conducted  in  the  library  of  Dr. 
Gerbode's  large,  art-filled  home  on  Divisadero  Street  in  San  Francisco.   The 
sessions  were  preceded  or  followed  by  lunch  and  conversation  in  the  dining 
room  overlooking  an  old  fashioned  flower  garden  and  San  Francisco  Bay. 

Editing:   The  transcribed  interviews  were  edited  with  an  eye  to  accuracy 
and  clarity.   In  a  very  few  instances  material  was  rearranged  for  the  sake  of 
continuity;  the  change  in  such  cases  is  noted  at  the  bottom  of  the  appropriate 
page.   Repetitions  understandably  occurred  because  of  the  long  period  (almost 
one  and  a  half  years)  during  which  the  interviews  were  conducted.   They  were 
not  eliminated  unless  they  added  no  further  information.   Dr.  Gerbode  reviewed 
the  edited  text  and  made  minor  deletions,  changes,  and  additions.   His  sudden 
death  prevented  his  editing  the  final  three  interviews. 

Note  on  terminology:   The  name  changes  of  several  institutions  with  which 
Dr.  Gerbode  was  associated  may  be  confusing  to  the  reader.   Stanford  Hospital 
in  San  Francisco  became  Presbyterian  Hospital  when  Stanford  University  moved 
its  medical  school  to  Palo  Alto  in  1959.   The  new  Presbyterian  Hospital,  whose 
operating  and  recovery  rooms  Dr.  Gerbode  helped  to  design,  opened  in  April 
1973.   In  1959,  the  Institutes  of  Medical  Sciences  (IMS)  were  organized  by 
Dr.  Gerbode  and  others  to  continue  the  medical  research  activities  of  Stanford 
Hospital.   In  1982,  the  name  of  the   IMS  was  changed  to  the  Medical  Research 
Institute.   The  organization  consisting  of  the  Presbyterian  Hospital,  the 
Medical  Research  Institute  and  several  other  buildings,  and  bordered  by  Clay, 
Sacramento,  Buchanan,  and  Webster  Streets,  is  now  known  as  the  Pacific 
Presbyterian  Medical  Center. 


Sally  Hughes 
Interviewer-Editor 

6  April  1985 

Regional  Oral  History  Office 

486  The  Bancroft  Library 

University  of  California  at  Berkeley 


*At  the  time  of  writing,  the  destination  of  Dr.  Gerbode's  correspondence  was 
unsettled. 


I  FAMILY  BACKGROUND,  EDUCATION  AND  EARLY  CAREER 
[Interview  1:   July  20,  1983 ]## 


Grandparents,  Parents,  Brother  and  Sisters 


Hughes:   Dr.  Gerbode,  could  you  tell  me  a  little  about  both  sets  of  grand 
parents,  what  their  names  and  professions  were,  and  where  they 
lived? 

Gerbode:   I  don't  know  too  much  about  my  grandparents,  because  they  were  in 
Europe,  except  for  one,  and  they  were  quite  old.   I  was  the  last 
of  four  children,  so  that  by  the  time;  I  came  along,  they'd  pretty 
much  vanished  from  the  scene.   But  in  any  event,  the  first  Frank 
Gerbode  came  to  California  in  1850.   He  apparently  came  through  the 
southern  route,  from  New  Orleans.   He  was  Frank  Albert  Gerbode  and 
the  first  one  in  California.   He  became  a  goldminer.   What  he  was 
before  he  was  a  goldminer,  I  don't  have  any  idea.   He  established 
a  homestead  in  El  Dorado  County  and  started  gold  mining.   When  he 
was  there,  he  hired  some  Chinese  and  French  [workers]  to  help  him 
with  what  was  then  a  pocket  mine.   We  still  have  the  property.   It's 
a  hundred  and  sixty  acres  in  El  Dorado  County.   It  hasn't  been 
mined  since  he  died  many  years  ago. 

He  brought  over  my  father,  Frank  Albert  Gerbode*,  from  Germany 
when  my  father  was  quite  young,  and  became  his  foster  father.   In 
other  words,  he  adopted  him  after  he  got  him  over  here.   My  father's 


##This  symbol  indicates  that  a  tape  or  a  segment  of  a  tape  has 
begun  or  ended.   For  a  guide  to  the  tapes  see  page  505. 

*Frank  Albert  Gerbode  II  was  the  nephew  of  Frank  Albert  Gerbode  I. 


Gerbode:  mother  was  named  Mary  Lewis.   She  was  an  English  woman  from 

London.   How  they  got  together,  I  haven't  any  idea.   But  apparently 
they  were  married. 

Then  on  my  mother's  side,  she  [Anna  Marie]  came  from  the 
Rhineland,  and  her  father  was  a  Scotchman  by  the  name  of  Leven. 
How  her  father  got  to  the  Rhineland  from  Scotland,  I  haven't  any 
idea. 

My  father  came  to  Placerville  and  eventually  started  a 
construction  business  and  built  several  small  towns  and  mining 
towns  in  El  Dorado  County.   He  was  a  hard-working,  honest  man.   He 
was  a  good  deal  older  than  I.   My  mother  was  forty-three  when  I 
was  born.*  My  father  was  fifty-three,  so  there  was  a  big  gap  of  age 
between  both  of  them  and  myself. 

Hughes:   Were  they  married  late? 

Gerbode:  Yes.   Then  they  had  four  children.   They  had  a  son  named  Albert,  who 
was  in  a  submarine  in  the  First  World  War.  He  settled  in  Florida 
after  the  war,  went  into  real  estate  and  was  quite  successful.   Then 
he  was  on  his  way  to  New  York  on  a  yacht  with  a  friend  of  his.   They 
had  to  stop  for  fuel,  and  in  the  skiff  in  which  he  was  rowing,  a  big 
wave  came,  the  fuel  tank  hit  him  in  the  head  and  knocked  him  out, 
and  he  was  drowned.  He  had  no  children. 

Hughes:   Was  this  right  after  World  War  I? 

Gerbode:   Soon  after  the  war.   I  had  an  older  sister  by  the  name  of  Louise, 
who  was  a  beautiful  girl.   She  died  of  acute  glomerular  nephritis 
a  few  days  after  she  graduated  from  high  school.   That  was  a 
tremendous  blow  to  my  mother  and  father. 

I  had  another  sister,  Gertrude,  who  became  a  business  woman 
and  worked  for  Blake,  Moffitt  and  Towne,  a  paper  company,  and 
became  an  expert  in  fine  paper.  She  was  quite  an  authority  on  where 
to  get  fine  paper  for  special  jobs. 

Hughes:   Is  she  alive? 

Gerbode:  No,  she  died  of  a  coronary  about  ten  years  ago.   So  that's  the 
family. 

Hughes:   Let  me  ask  you  a  question  about  the  name  Gerbode.   You  said  that 

your  real  father  was  German,  but  what  about  your  step  grandfather? 

Gerbode:  My  step  grandfather  was  from  near  Hanover. 


*February  3,  1907. 


Frank  Gerbode,  at  three  months  and  at  school  age 


Hughes:    So  Gerbode  is — 

Gerbode:   Gerbode  is  an  old  Saxon  name.   It's  a  strange  name.   Once  I  found 
a  Gerbode  in  the  telephone  directory  when  I  was  traveling  around. 
I  didn't  look  them  up  because  I  wasn't  sure  that  I  might  want  to 
get  connected  with  them.   You  never  know  what  you  might  run  into. 
There  are  some  big  advantages  in  having  a  name  that's  rare.   People 
know  who  you  are. 

A  friend  of  mine  in  Australia  once  was  curious  about  the  name. 
He's  a  voracious  reader,  and  he  found  an  old  Belgian  book.   In  it 
there  is  a  Count  Gerbod,  and  he  thought  this  probably  was  an 
ancient  ancestor.   He  apparently  was  a  soldier-type  who  lived  in  the 
early  fifteenth  century.   But  whether  that's  true  or  not,  I 
haven't  taken  the  trouble  to  find  out.   But  he  thought  this  was  a 
great  discovery,  that  he'd  found  a  Count  Gerbod,  who  was  apparently 
from  an  old  Belgian  family.   It's  possible,  because  it's  not  too  far 
from  Saxony.   I  suppose  if  I  wanted  to  spend  some  money,  I  could 
trace  it  all  back. 

Hughes:    I'm  interested  in  the  fact  that  your  father  was  adopted  by  your 
great  uncle.   Do  you  know  any  more  about  that? 

Gerbode:   No,  I  don't  know  why.   It  was  so  long  ago  by  the  time  that  I  got 

curious  that  none  of  us  in  the  family  really  paid  much  attention  to 
it.   I  guess  when  [my  great  uncle]  brought  him  over  here,  he  felt 
that  he'd  do  better  adopting  him  than  just  having  him  live  here. 

Hughes :   But  it  was  more  than  a  working  arrangement . 

Gerbode:   I  think  he  was  very  fond  of  him,  and  I  guess  helped  him  get  started 
in  his  business.   There's  the  old  miner's  cabin  there  on  the  wall, 
[points  to  photographs]   That's  the  original  miner's  cabin,  which 
my  father  and  I  rebuilt  when  I  was  seventeen  years  old,  using  some 
of  the  original  logs,  but  cutting  other  logs  from  the  same  property. 

Hughes:   Was  he  successful  as  far  as  the  gold  mining  was  concerned? 

Gerbode:   He  apparently  was  fairly  successful,  but  unfortunately,  he  was  very 
generous,  and  no  one  came  by  his  place,  I  guess,  without  leaving 
with  something.   He  hired  quite  a  few  people  to  help  him  with  that 
mine.   He  once  also  saved  old  man  Studebaker's  life.   The  original 
Studebaker  lived  up  there  at  the  same  time.   I  guess  they  were  out 
at  a  wild  party  some  Saturday  night.   He  pulled  him  out  of  a  creek 
before  he  drowned.   So  the  story  goes,  anyway. 


Hughes : 


Gerbode: 


Grammar  School  and  High  School  Education 

Let's  get  a  bit  more  detail  about  your  childhood, 
where  you  went  to  grammar  school? 


Do  you  remember 


Yes,  I  went  to  public  grammar  school  in  Sacramento.   I  went  through 
half  of  high  school  there,  too.   My  sister  was  living  in  San  Francisco, 
and  I  decided  I'd  rather  come  to  San  Francisco  to  finish  high  school. 
So  I  came  and  stayed  with  my  sister  and  her  husband ,  and  went  to 
private  school  to  finish  high  school. 


Hughes:   Which  school? 


Undergraduate  Education  at  Stanford 


Gerbode:   It  was  called  Raymond  School.   It  doesn't  exist  any  more,  but  it 

was  a  school  with  very  few  students.   I  finished  there,  and  then  I 
took  the  college  board  examinations  and  applied  to  the  University 
of  California  in  a  premedical  course.   I  didn't  like  the  University 
of  California.   I  went  for  a  summer  session,  and  I  found  it  highly 
competitive  and  too  big  for  me.   So  I  decided  I  didn't  want  to  go 
there. 

This  was  in  the  summer,  and  it  was  too  late  to  apply  to 
Stanford  then,  so  I  went  to  the  University  of  San  Francisco.   I  stayed 
there  until  I  could  get  into  Stanford,  which  was  a  year  or  so  later. 
Then  I  finished  my  premedical  courses  at  Stanford  and  went  into 
medical  school  there. 

Hughes:   What  about  this  decision  to  come  to  San  Francisco? 

Gerbode:  Maybe  I  had  a  feeling  Sacramento  was  too  small.   That  sort  of  sounds 
demeaning,  but  I  wanted  to  see  something  on  a  broader  basis.   I'd 
been  to  San  Francisco  a  few  times,  and  I  liked  the  atmosphere  in 
the  city  very  much.   I  had  a  good  opportunity  to  stay  with  my  sister, 
so  that's  what  I  did. 


Left: 

Frank  with  his  first  car  (?) 


Be  low  : 

Frank,  about  seventeen,  with 
his  father,  Frank  Albert 
Gerbode,  II,  at  the  log 
cabin  which  they  rebuilt  one 
summer  on  family  property 
near  Placerville,  California 


,  * 


The  Decision  to  Go  into  Medicine 


Hughes:   What  about  your  parents'  attitude  toward  education? 

Gerbode:   My  father  wanted  me  to  be  a  businessman.   I  don't  know  why  he 

thought  I  would  have  made  a  good  businessman,  but  to  satisfy  him, 

I  went  to  a  business  college  for  about  six  months  and  learned  how 

to  do  bookkeeping  and  accounting  and  a  few  things  like  that. 

Hughes:   That  was  in  Sacramento? 

Gerbode:   Sacramento.   I  got  a  good  job  for  about  six  months  with  the  Pacific 
Gas  and  Electric  Company  and  showed  him  that  I  could  do  it.   Then 
I  went  to  him  and  said,  "Now  I  showed  you  I  could  do  it,  but  I  don't 
want  to  do  it."  My  mother  wanted  me  to  be  an  architect. 

Hughes:   Why  did  she  have  that  idea? 

Gerbode:   I  don't  know.   She  thought  I  could  draw,  and  she  thought  it  was  a 
very  good  profession.   They  both  thought  being  a  doctor  would  take 
too  long,  and  maybe  it  was  uncertain.   It  was  a  kind  of  a  future 
that  they  hadn't  been  closely  familiar  with. 

Hughes:   There  was  nobody  in  the  family  in  the  medical  profession? 

Gerbode:   No. 

Hughes:   How  did  you  get  the  idea  to  go  into  medicine? 

Gerbode:   I  suppose  because  in  Sacramento  I  got  to  know  a  few  doctors,  and 
they  all  seemed  to  lead  quite  independent  lives,  which  I  liked. 
They  didn't  have  bosses,  and  they  weren't  beholden  to  anybody.   I 
think  the  independence  appealed  to  me,  as  well  as  being  able  to 
do  something  for  somebody  else.   So  I  think  it  was  the  independence 
and  the  desire  to  do  something  for  somebody  else  that  got  me 
started  on  it. 

Hughes:   Had  you  had  any  particular  interest  in  the  sciences? 

Gerbode:   No,  I  hadn't.   I  took  the  usual  courses  in  high  school,  but  I  can't 
say  that  I  was  very  good  at  them,  [although]  I  got  fairly  good 
grades.   I  think  all  the  courses  I  took  in  high  school,  and  later 
on  in  college,  were  to  accomplish  the  aim  of  getting  there.   If  they 
set  a  path  for  you  in  any  career,  and  they  say  you  have  to  go 
through  these  steps  to  get  there,  then  you  have  to  do  it.   So  I  did 
it. 


Extracurricular  Activities  at  Stanford 

Hughes:   What  about  extracurricular  activities? 

Gerbode:   I  didn't  do  too  much.  When  I  was  at  Stanford,  I  really  wanted  to 
play  tennis  and  do  some  other  things  like  that,  but  I  was  too 
worried  about  not  getting  into  medical  school.   So  I  really 
studied  very  hard.   I  got  very  good  grades. 

I  did  run  for  men's  council  at  Stanford,  though,  and  was 
elected.   Men's  council  is  a  student  body  group  which  governs  a  lot 
of  activities  and  sets  standards  for  students.   I  was  pleased  that 
they  elected  me. 

Hughes:   Was  that  your  first  taste  of  politics? 

Gerbode:   I  think  it  probably  was  the  first  time  I  ever  accepted  an  invitation 

to  run  for  an  office.  Later  on,  in  medical  school,  I  was  president 

of  the  student  body.   I  can't  say  that  I  worked  very  hard  to  get 
the  job,  but  they  elected  me  anyway. 

Hughes:   Does  that  imply  that  you  were  a  well-known  individual  in  medical 
school? 

Gerbode:   I  guess  maybe  nobody  else  wanted  the  job.   I  believe  I  was  pretty 
well  liked. 

Hughes:  What  year  of  medical  school  was  this? 

Gerbode:  Nineteen  thirty-six. 

Hughes:  So  this  was  your  last  year  at  medical  school. 

Gerbode:  Yes. 

Hughes:  Do  you  have  to  be  a  senior? 

Gerbode:  They  usually  elect  somebody  in  the  senior  class. 


Financing  the  Stanford  Tuition 


Hughes:   How  did  you  finance  the  Stanford  tuition? 

Gerbode:   I  worked  in  the  summer.   I  accepted  a  certain  amount  of  money  from 
my  parents.   I  won  a  scholarship  when  1  was  down  there,  too. 


Hughes:   This  is  medical  school  or  undergraduate? 

Gerbode:   Undergraduate.   I  kept  it  for  a  year.   It  was  a  scholarship  which 
paid  my  tuition.   I  also  worked  in  the  summers  at  various  jobs. 
When  I  ran  short  of  money,  I  would  call  my  family  for  support,  and 
he  always  helped,  but  I  didn't  really  depend  on  him  entirely. 
Although  he  would  have  helped  me  more  than  he  did,  I  didn't  want  to 
do  it  that  way  necessarily. 

Hughes:   Were  they  pleased  that  you  were  going  to  Stanford? 

Gerbode:   Yes.   I  think  it  scared  them  half  to  death  to  think  that  I  was 

going  to  try  to  become  a  doctor  rather  than  a  businessman,  but  they 
accepted  it  after  a  while. 


The  Major  in  Physiology 


Hughes:    I  know  you  majored  in  physiology.   Did  you  know  immediately  that 
that's  what  you  were  interested  in? 

Gerbode:   I  think  the  reason  I  got  involved  in  physiology  was  that  I 

realized  that  this  was  a  science  very  close  to  medicine.   Also  I 
had  an  opportunity  to  do  research  in  the  summer  in  the  department 
of  physiology,  and  I  liked  the  idea  that  I  could  start  doing 
research  as  an  undergraduate. 

My  brother  probably  is  responsible  in  part  for  that,  because 
he  was  also  very  interested  in  research  and  worked  with  Thomas 
Edison  for  quite  a  while  on  electrical  devices.   Even  when  he  was 
in  real  estate,  he  worked  some  with  Edison.   Maybe  my  brother  was 
a  hero  to  me  in  a  way,  and  maybe  I  thought,  "If  he  can  do  it, 
maybe  I  should  try  to  do  it,  too." 

Hughes:   Did  he  have  any  special  background? 

Gerbode:   He  was  trained  in  electrical  engineering,  and  he  was  on  a  submarine 
during  the  First  World  War  as  a  trained  electrical  engineer. 
Submarines  run  on  electricity,  so  they  need  people  who  can  understand 
it.   I  guess  maybe  he  inspired  me  in  a  way  which  he  didn't  know  about. 
Then  when  I  had  the  opportunity  to  do  research  at  Stanford  in  the 
summer  in  the  physiology  department,  I  was  rather  intrigued  with 
the  possibility  of  making  a  discovery.   It  was  a  very  good  summer. 

Hughes:   Can  you  tell  me  about  your  first  research  project? 


8 


Gerbode:  The  first  research  project  was  like  Pavlov's  experiment,  and  it 
was  to  teach  cats  to  go  a  certain  way  through  a  maze.   I  had  to 
construct  a  maze  and  train  them  in  avoiding  certain  turns  in 
this  maze  to  get  at  the  food.   It  was  an  experiment  in  conditioned 
reflexes. 

Hughes:   Was  this  something  that  somebody  in  the  department  was  interested 
in? 

Gerbode:  Yes. 

Hughes:   What  was  the  standing  of  the  department  of  physiology? 

Gerbode:  The  department  of  physiology  was  one  of  the  good  departments.   It 
wasn't  outstanding.   Unfortunately,  at  the  time  they  were  changing 
the  chairmanship,  and  the  two  men  who  were  assistants  to  the  chief 
were  not  sure  about  their  future ,  and  the  chief  was  not  very 
effective.   But  one  of  the  young  men  who  was  second  in  command  was 
the  one  who  helped  me  do  the  research. 

Hughes:   What  was  his  name? 

Gerbode:   Victor  Hall. 

Hughes:   Were  you  seeing  this  research  as  a  tie-in  with  medicine? 

Gerbode:   I  was  thinking  it  might  help  somewhere  along  the  line.  At  the  same 
time  I  took  a  minor  in  psychology.   So  it  was  part  of  the  same 
concept  of  understanding  things  about  the  mind,  I  guess,  that  got 
me  started. 

Hughes:   Were  you  toying  with  the  idea  of  specializing  in  psychiatry? 
Gerbode:   No.   At  that  time  I  thought  maybe  I  might  be  a  roentgenologist. 
Hughes:   Why? 

Gerbode:   Because  I  had  met  a  couple  of  roentgenologists,  and  they  seemed 
to  be  connected  with  all  the  various  specialties  and  had  to 
understand  everything  to  understand  the  xrays  properly.  So  I  felt 
this  was  quite  good.   They  also  were  quite  independent  as 
individuals,  and  this  appealed  to  me  as  well. 

Hughes:   What  changed  your  mind? 

Gerbode:  There  were  too  many  other  fascinating  things  as  time  went  on. 


The  Decision  to  Become  a  Surgeon 


Hughes : 
Gerbode: 

Hughes: 
Gerbode: 


Hughes: 
Gerbode: 


Hughes: 


Gerbode: 


When  did  you  decide  that  it  was  going  to  be  surgery? 

I  decided  that  after  my  sophomore  year.   I  think  I  decided  that 
I  could  do  it,  and  if  I  could  do  it,  then  that's  what  I  probably 
should  do. 

Do  it  in  what  sense? 

Manually  do  it.   And  the  other  thing  is,  when  I  came  up  here  to 
the  campus....   You  see,  the  second  year  [of  medical  school]  was  in 
San  Francisco.   It  was  in  the  old  Cooper  Medical  School  building, 
which  was  then  the  Stanford  Medical  School.   I  got  interested  in 
research  as  a  student  in  the  surgery  department.   That  helped  me, 
because  then  I  could  operate  on  animals  and  do  certain  experiments. 
The  one  who  helped  me  with  that  was  Professor  [F.L.]  Reichert.   He 
got  me  interested  in  doing  research.  Dr.  [Emile]  Holman,  who  was 
the  professor,  was  also  very  keen  on  doing  animal  research.   He 
did  a  lot  of  experiments,  and  I  started  helping  him  as  well. 

Was  that  unusual  for  a  medical  student  to  be  engaged  in  research? 

No,  not  so  unusual.   There  were  always  a  few  medical  students  who 
were  doing  some  research.   I  would  say  that  the  vast  majority  did 
not  do  anything  like  that,  but  there  were  always  two  or  three  or 
four  in  every  class  who  were  interested.   Later  on  when  I  was  on 
the  faculty  and  found  a  student  who  was  interested  in  doing  research, 
I  was  very  anxious  to  help  him,  because  I  knew  what  pleasure  he 
was  going  to  get  out  of  it .   We  had  several  students  in  the  old 
lab  whom  I  helped  get  started,  who  are  now  professors  of  surgery. 

One  of  them  was  a  biomedical  engineer.   He  had  two  degrees 
from  Stanford,  one  in  biology,  and  the  other  in  engineering.   He 
went  to  Cornell  as  an  intern,  and  he  soon  was  doing  better  research 
in  the  medical  school  than  some  of  the  senior  departmental  people, 
because  he  was  trained  properly,  and  he  had  the  experience  in  the 
laboratory,  so  he  knew  what  to  do. 


Was  the  European  model  of  medical  research  still  in  force? 
very  early  that  Germany  was  held  up  as  the  prototype. 


I  know 


The  big  thing  in  those  days  was  Vienna,  but  Vienna  was  not  so 

well  known  for  research  as  they  were  for  pathology.   The  people  who 

went  over  to  Germany  in  surgery,  when  they  came  back,  were  very 


10 


Gerbode:   accepted.  They  were  accepted  because  they  presumably  had  had 
exposure  which  they  couldn't  get  in  this  country.   Vienna,  and 
Scotland,  too,  had  very  good  reputations  for  training  young  men. 

Hughes:   You  were  already  thinking  of  combining  surgery  with  research? 

Gerbode:  Yes. 

Hughes:   In  an  academic  setting? 

Gerbode:  Yes.   I  never  really  stopped  doing  it,  either.   I  started  doing  it 
as  a  student,  and  I  did  it  when  I  was  in  training.  As  soon  as  I 
came  back  from  the  war,  I  started  right  back  in  the  experimental 
laboratory. 


The  Stanford  Medical  Curriculum  in  the  1930s 


Hughes : 
Gerbode: 


You  were  in  medical  school  between  1932  and  1936. 
Depression.  Did  that  influence  you  in  any  way? 


This  was  the 


Hughes : 
Gerbode: 
Hughes : 
Gerbode: 
Hughes : 
Gerbode; 


Nobody  really  had  very  much  money  in  those  days.   I  was  able  to 
have  a  little  car.   I  had  a  little  Ford.   The  medical  school  was 
clinically  oriented.   It  was  an  Oslerian  type  of  medical  school, 
built  on  studying  the  patients  and  teaching  from  them,  so  we  had 
lots  of  contact  with  patients,  even  as  students.  And  lots  of 
contact  with  the  professors,  too. 

The  first  year? 

In  the  sophomore  year,  not  in  the  freshman  year. 

The  freshman  year  was  at  Stanford. 

Yes. 

In  the  basic  sciences? 

That  was  anatomy  and  biochemistry  and  physiology.   The  old  Stanford 
Medical  School  was  built  around  sick  people.  The  science  and  the 
practice  was  built  on  the  [medical]  problem.  There  were  fewer 
lectures  than  in  some  schools,  so  it  wasn't  a  didactic  kind  of 
school.  A  lot  of  people  still  think  that  that's  a  much  better  way 
to  teach  than  with  lectures. 


11 


Hughes:   What  subjects  did  you  take  in  the  second  year? 

Gerbode:   It  was  required  that  we  took  physical  diagnosis,  history  taking 
and  learning  how  to  write  orders,  and  pharmacology.   I  found 
pharmacology  pretty  hard.   I  don't  know  why.   I  got  a  B  in  it 
finally,  but  it  didn't  come  easily  for  me  for  some  reason.   I 
think  the  professor  scared  me. 

Hughes:   Do  you  think  it  was  the  chemistry? 
Gerbode:   It  may  have  been  the  chemistry. 

Hughes:   Were  you  finding  that  your  undergraduate  education  was  holding  you 
in  good  stead? 

Gerbode:   I  think  it  was  all  right.   I  managed  to  get  good  grades.   I  could 
understand  what  was  going  on  all  the  time. 

Hughes:   Was  the  medical  school  pulling  from  all  over  the  country,  or  was  it 
a  local,  California  school? 

Gerbode:   They  brought  students  from  all  over  the  country,  but  most  of  them 
were  Calif ornians. 

Hughes:   What  was  its  reputation? 

Gerbode:   It  was  considered  among  the  top  medical  schools  in  the  country. 


Research  in  Medical  School 


Hughes:   Tell  me  a  little  about  the  research  that  you  did  in  medical  school. 

Gerbode:   I  got  interested  in  some  research,  first  of  all,  on  a  certain 

inflammatory  disease  of  the  intestine.   Nobody  could  find  out  why 
it  occurred  in  certain  people,  so  we  tried  to  simulate  it  in  the 
experimental  animal.   Professor  Reichert  thought  it  was  due  to 
obstruction  of  the  lymphatic  system  of  the  small  intestine,  so  we 
had  to  try  to  design  an  experiment  which  would  prove  or  disprove 
that.   I'm  not  sure  that  we  ever  proved  that  it  was  caused  by 
that,  but  we  spent  a  lot  of  time  on  it.   I  wrote  a  couple  of  papers. 

Hughes:   Was  there  anything  else? 


12 


Gerbode:   Later  on  I  got  interested  in  the  heart  and  did  some  experiments 
to  create  certain  congenital  abnormalities  in  the  experimental 
animals,  so  that  we  could  study  them,  and  the  animal  that  had 
that  disease.   This  was  great  fun,  and  I  liked  that  very  much. 

Hughes:   Why  the  heart? 

Gerbode:   1  guess  because  some  of  us  felt  that  this  was  going  to  be  the  next 
frontier  in  surgery.  The  other  thing  was,  Dr.  Holman  was  very 
interested  in  curculation  and  the  heart.   I  helped  him  with  a  lot 
of  cases  connected  with  the  major  vessels.  Also,  he  had  done  some 
experiments  on  the  heart  as  a  medical  student  at  Hopkins,  and  I 
guess  this  interested  me  as  well.   I  began  to  read  about  what 
the  previous  generation  had  done,  and  tried  to  understand  what  was 
happening  in  the  circulation.   Probably  the  fact  that  I  had  taken 
physiology  for  more  than  the  average  amount  of  time  fitted  in  well 
with  trying  to  understand  the  heart  and  circulation. 


Emile  Holman,  Surgeon 


Hughes:   Holman  [was  your  mentor]? 
If 

Gerbode:  As  soon  as  1  decided  1  wanted  to  be  a  surgeon,  then  [Holman]  was 
my  boss.   He  had  a  very  fine  reputation  in  the  country  as  an 
experimental  surgeon,  but  also  because  he  was  the  last  resident 
trained  under  [William  S.]  Halsted,  who  was  the  father  of  American 
surgery.   [Holman]  also  started  the  residency  type  of  training  at 
Stanford  Medical  School. 

Hughes:   Do  you  remember  when  that  was? 

Gerbode:   I  think  he  came  out  in  the  twenties  from  Hopkins  and  started  the 
residency  type  of  training,  which  then  followed  right  straight 
through  until  he  retired. 

Hughes:   Was  he  American? 

Gerbode:  Yes.   He  was  the  son  of  a  minister.   This  also  came  out  in  many  of 
the  things  he  did,  in  his  personality. 

Hughes:   Can  you  expand  a  little  on  that? 


13 


Gerbode:   He  had  strong  feelings  about  right  and  wrong.   He  was  of  German 
ancestry,  and  this  was  also  very  apparent.   So  he  combined  some 
of  the  things  he  picked  up  from  his  father  with  his  Germanic 
background;  it  brought  out  a  very  strong  person. 

Hughes:    I'm  sure  that  influenced  your  relationship. 
Gerbode:   I  had  to  cope  with  it. 
Hughes:   He  was  very  much  the  boss. 

Gerbode:   No  question  about  it,  he  was  the  boss.   And  if  you  did  something  he 
didn't  like,  he  told  you  right  away.   There  was  no  question  about 
that. 

Hughes:   Was  he  a  general  surgeon? 

Gerbode:   He  started  out  being  a  general  surgeon,  but  he  really  finished  by 
being  a  general  and  a  thoracic  surgeon.   He  also  made  his 
reputation  by  being  one  of  the  early  vascular  surgeons,  although 
he  didn't  do  many  of  the  new,  innovative  things  as  a  vascular 
surgeon.   He  was  mainly  interested  in  arteriovenous  fistulas,  which 
are  connections  between  the  arteries  and  the  veins.   These 
connections  produce  certain  physiological  changes  in  the  veins 
and  in  the  circulation,  which  interested  him  a  great  deal.   He  spent 
most  of  his  experimental  life  working  on  these  particular 
abnormalities . 

Hughes:    In  animals? 

Gerbode:   In  animals  and  in  humans,  too.   Some  [arteriovenous  fistulas]  are 
congenital ,  and  some  are  the  result  of  stab  wounds  or  gunshot 
wounds.   So  we  always  had  a  certain  number  of  patients  around  with 
these  abnormalities.   For  somebody  interested  in  the  circulation, 
this  was  very  good. 

Hughes:   And  the  fistulas  could  occur  anywhere  in  the  body? 

Gerbode:   Usually  they  were  between  the  major  vessels,  like  the  femoral 
vessels  or  iliac  vessels  or  arm  vessels. 

Hughes:   That  would  mean  operating  right  around  the  pericardium. 

Gerbode:   Operating  there,  and  also  on  the  major  vessels. 

Hughes:   Which  I  believe  was  very  unusual  in  the  prewar  days,  was  it  not? 


14 


Gerbode:   Yes,  it  was  unusual. 

Hughes:   My  understanding,  from  the  little  reading  I've  done,  is  that  the 
heart  was  considered  until  World  War  II  to  be  surgically 
inviolate. 

Gerbode:  Oh,  yes.   There  were  some  German  surgeons  who  said  that  any  surgeon 
who  ventured  to  operate  upon  the  heart  was  virtually  insane. 
[C.A.  Theodor]  Billroth  was  one.   The  first  stab  wound  was  repaired 
by  [Ludwig]  Rehn  in  1896,  I  believe. 

Hughes:   Were  you  actually  participating  in  surgery  on  humans  at  this 
point? 

Gerbode:  Not  as  a  medical  student.   We  were  required,  if  we  had  a  patient 
assigned  to  us  on  the  wards,  to  follow  the  patient  through  the 
operating  room,  so  I  did  help  operate  upon  patients  by  being  an 
assistant,  such  as  holding  a  retractor.   But  most  of  [the  surgical] 
work  came  during  or  after  the  war. 

Hughes:   Would  you  consider  yourself  a  protege  of  Holman? 
Gerbode:  Yes. 

Hughes:   Were  there  other  people  on  the  faculty  with  whom  you  had  a  special 
relationship? 


F.L.  Reichert,  Neurosurgeon 


Gerbode:  Reichert,  the  professor  of  neurosurgery,  influenced  all  of  us  a 

great  deal.   He  was  very  interested  in  the  residents,  very  interested 
in  training,  and  very  hard  on  us  if  we  did  things  wrong.   He 
watched  our  careers  a  great  deal.  Sometimes  even  more  than  Holman. 
He  was  more  interested  in  seeing  that  the  young  men  got  on  in 
their  careers,  and  very  interested  in  getting  things  published.   He 
was  always  available  for  advice. 

He  wanted  me  to  be  a  neurosurgeon  and  almost  killed  me ,  I 
think,  when  I  told  him  I  didn't  want  to  be  a  neurosurgeon.   The 
reason  I  didn't  want  to  be  a  neurosurgeon  simply  was  because,  for 
all  the  hard  work  they  did  on  the  nervous  system,  there  were  very 
few  patients  who  got  well.  We  worked  terribly  hard  keeping  them 
alive  during  my  residency  period.   Long  hours  of  operating  upon 
them,  and  then  you'd  end  up  by  having  somebody  that  was  paralyzed 
or  a  vegetable. 


15 


Hughes:   Was  it  mainly  the  length  of  the  operation? 

Gerbode:  No.  The  brain  is  a  very  sensitive  organ.  If  it  gets  a  tumor, 
unless  it's  one  of  the  rare  benign  tumors,  you  can  keep  people 
alive,  but  they  are  not  very  well  when  they're  alive. 

Hughes:    So  it  was  the  poor  success  rate  that  discouraged  you. 

Gerbode:   Yes.   Actually,  a  great  many  young  men  were  quite  entranced  with 
the  idea,  brain  surgery  being  the  big  thing  when  I  was  a  young 
surgeon.   It  was  very  exciting  to  be  a  brain  surgeon,  or  to  be 
training  as  a  brain  surgeon.   I  didn't  like  the  poor  yield. 

Hughes:   And  yet  some  people  would  have  considered  that  you  had  jumped  from 
the  frying  pan  into  the  fire  by  turning  to  cardiac  surgery. 

Gerbode:   Yes,  I  think  so,  but  on  the  other  hand,  I  could  see  that  [cardiac] 
conditions  could  be  mechanically  corrected,  if  you  could  just 
figure  out  how  to  do  it,  and  you  didn't  end  up  by  having  somebody 
who  was  decerebrate  or  paralyzed. 

Hughes:   Were  you  doing  a  fair  amount  of  reading  at  this  time,  too? 
Gerbode:   Yes. 

Hughes:   Did  the  fact  that  you  were  doing  so  much  practical  work  mean  that 
there  wasn't  a  lot  of  bookwork  connected  with  your  studies? 


Cardiovascular  Surgery  Before  World  War  II 


Gerbode:   The  reading  in  cardiovascular  surgery  was  very  limited  at  that  time, 
when  I  was  in  my  early  training  years,  because  there  wasn't  very 
much  going  on. 

Hughes:   What  was  there? 

Gerbode:   In  medical  school  there  was  very  little.   During  the  war,  we  got 

more  of  it.   But  before  I  went  into  the  war,  around  that  time,  some 
of  the  first  heart  operations  were  beginning  to  be  done.   This  was 
very  exciting,  to  see  that  you  could  physiologically  improve 
somebody  with  an  operation  on  the  heart,  and  you  had  a  living  person 
who  then  could  walk  and  work  and  be  effective  again. 


16 


Hughes:   A  few  people  were  trying — I  believe  it  was  in  the  twenties — to 

do  mitral  valve  surgery.   Then  there  was  a  great  hiatus  until  the 
postwar  years. 

Gerbode:  Yes,  that's  right.   I  was  very  fortunate,  because  I  was  there  at 
the  right  time.   I  guess  that  some  of  the  first  operations  were 
done  by  people  like  Elliott  Cutler  at  [the  Peter  Bent]  Brigham 
Hospital.   Then  there  was  a  fellow  by  the  name  of  [Sir  Henry  Sessions] 
Scouttar,  an  Englishman,  who  did  one  of  the  first  mitral  valve 
operations.   But  a  lot  of  people  thought  that  both  of  them  were  a 
little  bit  off  their  rockers  for  trying  it. 

Hughes:   They  both  had  trouble  getting  patients,  did  they  not? 

Gerbode:  Oh,  they  had  terrible  trouble.   But  we  also  had  trouble  here  later 
on.* 

Hughes:   Had  Cutler  and  Holman  had  any  contact? 

Gerbode:  Yes,  they  were  associated  because  Dr.  Holman  was  at  the  Brigham 
for  a  little  while.  After  his  residency  at  Hopkins,  he  went  to 
Brigham  for  a  year  or  two.   They  got  to  know  each  other  then. 
There  was  another  fellow  who  was  around  at  that  time  at  Hopkins 
by  the  name  of  Mont  Reid.   He  went  to  Cleveland  and  he  was  also 
interested  in  the  circulation.   Halsted  was  the  one  that  started 
thinking  about  the  circulation.   He  did  simple  things,  like  tying 
off  an  artery,  but  illustrated  some  very  fundamental  points  about 
the  circulation  in  so  doing. 

Hughes:   And  that's  probably  what  got  Holman  started. 
Gerbode:  That's  right. 

Hughes:   Did  you  have  any  time  for  extracurricular  activities  during  medical 
school? 


Marriage 

Gerbode:   I  was  married  in  1931. 

Hughes:   So  just  before  you  started  medical  school? 


*The  problem  of  the  resistance  of  cardiologists  to  heart  surgery  is 
discussed  in  session  5,  8/16/83. 


17 


Gerbode:  Yes,  my  last  year  at  Stanford. 

Hughes:  Was  that  a  bit  unusual  in  those  days? 

Gerbode:  A  little. 

Hughes:  How  did  you  handle  it  financially? 

Gerbode:   My  wife,  Martha  Alexander  Gerbode,  had  a  little  money,  and  between 
the  two  of  us,  we  were  able  to  make  it  go.   She  had  quite  a  bit 
more  money  than  I  did. 

Hughes:    So  she  didn't  have  to  work. 
Gerbode:   She  didn't  have  to  work. 
Hughes:   Tell  me  how  you  met. 

Gerbode:   We  met  in  the  experimental  psychology  class  at  Stanford.   My 

parents  had  meanwhile  moved  to  Piedmont  across  the  bay  and  her 
parents  were  in  Piedmont,  too.   So  we  started  riding  back  and  forth 
to  Stanford  together. 

Hughes:   Does  that  mean  you  lived  at  home? 

Gerbode:   No.   I  went  home  for  weekends.   That's  how  we  got  to  know  each 
other. 

Hughes:   Why  did  your  parents  move  to  Piedmont? 

Gerbode:   I  can't  remember  why  they  did.   But  I  guess  it  was  because  my  sister 
was  living  in  the  Bay  Area,  and  they  wanted  to  live  closer  to  her. 
It  wasn't  because  of  me,  because  I'd  already  wandered  off  into  .this 
academic  path. 

Hughes:   Where  did  you  live? 

Gerbode:   We  lived  at  Stanford  together.   First,  we  rented  a  little  house. 
Then  when  I  came  up  to  medical  school  here,  we  lived  in  a  nice 
little  brown  house  on  Broadway.   We  had  our  first  child  there,  a  son, 
Wallace  Alexander. 

Hughes:   What  year  was  that? 

Gerbode:   I  think  that  was  about  1933.   He  subsequently  was  killed  at 
Stanford  in  an  auto  accident. 


18 


Hughes:    How  old  was  he? 
Gerbode:  He  was  nineteen.* 


Internship  at  Highland  Hospital,  1935-1936 


Hughes:   Tell  me  about  your  internship  at  Highland  Hospital  in  Oakland. 

Gerbode:   By  the  time  I  finished  medical  school,  I  decided  I  wanted  to  try 
to  be  a  surgeon.   I  felt  that  if  I  got  into  a  regular  surgical 
training  program,  then  I  wouldn't  have  an  opportunity  to  deliver 
babies  and  do  a  lot  of  things  in  general  medicine.   So  I  decided 
a  year  of  rotating  internship  would  be  good  for  me. 

Hughes:   This  was  before  you  graduated,  is  that  not  true? 

Gerbode:  Yes,  you  took  your  internship  before  they  gave  you  the  degree. 

Hughes:   It  was  still  four  years? 

Gerbode:   Still  four  years,  and  then  another  year  before  they  gave  you  a 

degree.   But  anyway,  the  other  reason  was,  my  mother  was  very  sick. 
She  was  in  Piedmont,  and  she  was  bedridden.   We  had  one  son,  so  I 
wanted  her  to  have  the  pleasure  of  seeing  her  grandson.  My  wife's 
mother  was  also  not  well.   [We  were]  the  only  family  they  had 
really.   So  I  felt  it  was  better  to  be  over  there  and  let  them  see 
the  grandson  and  see  more  of  us,  too. 

Hughes:   Can  you  describe  your  internship? 

Gerbode:   It  was  very  hard  work.   I  was  sick  twice  during  it,  because  I  just 
got  worn  out.   I  got  sore  throats  and  all  kinds  of  things.   I 
really  took  it  very  seriously. 

Hughes:   Were  you  getting  paid  anything  in  those  days? 
Gerbode:  Yes,  fifty  dollars  a  month.   [laughter] 
Hughes:   For  twenty-four  hour  days. 


*Discussion  of  Gerbode  family  members  and  property  on  Hawaii  was 
incorporated  in  later  sections  of  the  interview  transcripts. 


Gerbode: 

Hughes : 
Gerbode: 

Hughes : 
Gerbode: 

Hughes : 
Gerbode: 

Hughes : 
Gerbode: 

Hughes : 
Gerbode : 


Gerbode: 


19 


I  think  the  most  I  ever  made  as  a  resident  was  sixty  dollars  a 
month  and  room  and  board  and  laundry.   Now  they  get  paid  over  a 
thousand  a  month. 

You  were  living  at  the  hospital? 

No.   We  found  a  little  house  in  Piedmont,  and  rented  it.   Once  in 
a  while  I  had  to  stay  the  night,  of  course,  when  we  had  some 
special  thing  to  do. 

Did  Highland  have  any  special  reputation? 

It  was  a  favorable  place  for  a  general  rotating  internship.   It  had 
a  loose  connection  with  Stanford. 

Stanford  rather  than  UC?  Do  you  know  why  that  was? 

I  guess  because  several  of  the  people  who  became  prominent  in 
running  the  place  were  Stanford  graduates. 


I  was  just  too 


What  about  research? 

No,  there  was  nothing  at  all.   I  had  to  drop  that, 
busy  taking  care  of  sick  people. 

Did  you  learn  a  lot  from  that  experience? 

I  took  out  a  lot  of  tonsils.   I  delivered  a  lot  of  babies.   I  helped 
at  a  lot  of  gynecological  operations  and  things  like  that,  which  I 
never  really  ran  into  afterwards,  but  I'm  glad  I  did  it. 

I  was  glad  once,  years  later,  when  I  was  up  at  Lake  Tahoe,  and 
the  clerk  at  the  desk  said,  "There's  a  lady  in  labor  in  room  X-Y-Z, 
and  she  found  out  that  you  are  a  doctor.   Would  you  mind  going  to 
see  her?"   [laughs]   So  I  went  up  to  see  her.   She  was  certainly 
in  labor,  all  right,  but  not  too  far  along.   I  said,  "Why  did  you 
come  here  when  you're  [about  to]  have  a  baby?"  She  said  we  just 
went  to  various  resorts  until  we  found  there  was  a  doctor  registered. 

H 

Dr.  Leo  Eloesser  was  a  good  friend  of  mine.   He  was  one  of  the 
famous  professors  [at  Stanford  San  Francisco  Hospital].   He  had 
operated  upon  my  mother,  my  father-in-law,  and  my  mother-in-law. 
He  had  an  extremely  interesting  life  which  has  just  been  written 
up  by  Harry  Schumacher.   He  liked  me  and  was  interested  in  me.   Of 
course,  I  got  to  know  him  fairly  well  because  of  his  having 


20 


Gerbode:  operated  upon  the  family  so  much.   So  I  went  to  him  and  said, 

"I  want  to  go  into  surgery  eventually ,  but  I  want  to  go  to  Highland 
Hospital  for  my  internship  because  I  want  that  experience." 

He  said,  "Get  out  of  that  place  as  soon  as  you  can."  He 
didn't  like  the  idea  at  all. 

Hughes:   What  was  his  reason? 

Gerbode:   It  wasn't  a  big  teaching  hospital  like  our  county  hospital 

[San  Francisco  General].   If  I'd  said  I  wanted  to  do  the  same  here, 
it  would  have  been  all  right ,  because  he  was  the  chief  Stanford 
surgeon.   People  are  that  way.   I  wasn't  surprised. 


Assistant  in  Pathology  at  the  University  of  Munich,  1936-1937 


Gerbode:  There  are  two  reasons  why  I  went  to  Germany.   First  of  all,  by  that 
time  I  had  decided  I  was  going  to  try  to  be  a  surgeon,  and  I  felt 
that  pathology  would  be  very  important  in  the  training  of  a 
surgeon.  Now  the  belief  is  that  physiology  is  a  better  preparation 
for  surgery  than  pathology. 

There  were  two  great  German  pathologist.s,  world  famous.   One 
was  [K.A.  Ludwig]  Aschoff  and  one  was  [Max]  Borst.   Aschoff  was 
[head  of  the  Institute  of  Pathological  Anatomy]  in  Freiburg,  and 
Borst  was  in  Munich.   So  I  did  a  little  research  on  it,  and  I 
found  out  that  Aschoff  was  a  Nazi,  or  at  least  he  was  playing  with 
the  Nazi  party,  and  Borst  was  not  a  Nazi.   He  didn't  come  out 
against  [Nazism],  but  he  wouldn't  join  anything  connected  with  it. 
The  Nazis  didn't  dare  do  anything  to  him,  because  he  was  too 
famous.  As  long  as  he  didn't  do  anything  overtly,  they  let  him 
alone.   Then  I  heard  also  that  he  was  a  very  fine  gentleman.   So  I 
wrote  to  him  and  asked  him  if  he  would  take  me  on  as  a  fellow  for 
a  year. 

Hughes:   Was  this  the  thing  still,  to  go  to  Germany? 

Gerbode:  No,  not  necessarily.   Some  went  to  Germany.   Some  went  to  other 
countries. 

Hughes:   But  it  was  usual  for  an  American  to  go  abroad? 

Gerbode:  Not  necessarily,  no. 
[interruption] 


21 


Gerbode:   Another  man  on  the  Stanford  faculty,  Alvin  Cox,  a  pathologist,  went 
with  Aschoff  the  same  year  that  I  went  to  Borst.   I  found  Borst 
to  be  an  extremely  nice  gentleman,  a  real  cavalier  of  the  old 
school.   We  hit  it  off  perfectly. 

The  other  reason  I  went  was  because  I  was  curious  to  know 
what  was  happening  in  Central  Europe  at  that  time.   The  Nazis  were 
getting  terribly  strong  and  talking  a  lot  about  things  which  I 
thought  were  very  important  to  the  world.   So  I  decided  if  I  went 
there,  I  could  really  look  it  over  a  bit  without  getting  involved 
and  at  the  same  time  get  this  training  in  pathology. 

Borst  gave  me  the  job,  which  meant  I  had  a  little  lab.   I  went 
there  every  morning,  went  through  the  whole  business  of  pathology 
every  day,  and  went  to  the  lectures.   It  was  a  very,  very 
interesting  time.   Then  my  wife  and  I  had  to  find  a  place  to  live, 
and  we  almost  gave  up  in  desperation.   We  were  living  in  a  tiny 
hotel  in  Munich.   Finally  somebody  said,  "We  know  a  woman  from 
Boston  who's  got  a  house  just  outside  of  Munich,  and  she  rents  it 
once  in  a  while."  So  meanwhile  I'd  gotten  myself  a  little  Ford,  and 
we  went  out  and  found  this  beautiful  house  outside  of 
Munich  in  Geiselgasteig.   That's  where  the  movies  are  made  now. 
They  were  beginning  to  make  movies  then,  too.   She  said,  "I'm 
terribly  glad  to  see  you,  because  I  want  to  leave  very  shortly,  and 
I'd  much  rather  have  somebody  living  in  the  house."  She  said,  "You 
can  have  my  servants,  too." 

So  we  had  this  beautiful  house  with  a  driver  and  a  cook  and 
an  upstairs  maid  on  practically  nothing.   I  was  a  young  doctor,  and 
she  liked  me.   She  was  married  to  a  wealthy  banker  from  Boston,  so 
the  money  didn't  make  any  difference  to  her.   So  we  moved  in  very 
promptly.   We  had  one  son  at  that  time,  the  one  that  was  killed 
later.   The  living  part  was  wonderful.   Johann,  the  man-servant, 
was  terribly  excited  that  I  had  a  little  Ford.  He  was  a  good  driver, 
so  he  would  drive  my  wife  to  do  shopping  once  in  a  while.   The 
lady  had  him  fitted  out  with  various  uniforms  for  every  occasion. 
So  when  he  went  into  town,  he  had  a  driver's  uniform.   By  the  time 
you  drove  up  in  front  of  the  house,  he'd  go  around  to  the  back  of 
the  house  and  open  the  door  for  you  with  a  white  coat  on. 

Hughes:   Wonderful!   How  is  and  was  your  German? 

Gerbode:   I'd  taken  two  years  of  German  at  Stanford.   I  could  just  barely  get 
by,  but  the  conversational  German  came  to  me  fairly  easily,  because 
of  the  German  I  had  at  Stanford.   I  can  still  converse  in  German 
to  a  certain  extent  if  it  isn't  too  complicated. 

Hughes:   And  the  lectures,  of  course,  were  in  German. 


22 


Gerbode:  The  lectures  were  in  German  and  I  finally  began  to  understand  what 
they  were  talking  about. 

Hughes:   Was  pathology  in  Germany  a  different  beast  than  the  pathology  you 
had  been  exposed  to  at  Stanford? 

Gerbode:  Much  more  serious.   Every  person  who  dies  in  a  hospital  in  Germany 
is  autopsied  and  studied.   It's  a  law,  so  it's  a  very  important 
part  of  the  whole  structure  of  medicine. 

Hughes:   How  much  pathology  had  you  had? 

Gerbode:   I'd  had  the  regular  courses  in  pathology  in  medical  school,  which 
was  about  a  year.   But  in  any  event,  at  that  time  Nazism  was  just 
beginning  to  get  pretty  strong  in  Germany,  and  of  course,  Munich 
was  where  it  all  started.   I  began  to  notice  driving  into  the 
institute  in  the  morning  that  there  were  a  lot  of  men  out  crawling 
through  the  mud  and  through  barbed  wire  and  marching. 

One  time  the  whole  southern  German  army  went  on  maneuvers  and 
came  back  and  paraded  through  Munich.   They'd  obviously  been  put 
through  the  most  severe  training  you  could  imagine.   I  didn't  want 
to  go  to  jail  over  there.   I  wanted  to  finish  my  year,  so  we  were 
very  careful  not  to  break  any  laws. 

However,  once  we  decided  to  go  to  Innsbruck,  which  is  in  Austria, 
and  at  that  time  the  widow  of  the  professor  of  surgery,  Mrs.  Ernest 
Ophuls,  was  over  there,  too.   She  was  one  of  the  great  ladies  of 
San  Francisco.   Even  later  in  life  she  wore  a  dickie  all  the  time. 
She  looked  us  up  as  soon  as  I  got  there  and  was  very  friendly.   She'd 
been  going  over  every  year  to  some  place  in  Switzerland  or  Germany 
or  Austria,  and  just  happened  to  be  nearby  when  we  were  there.   So 
we  went  to  Innsbruck  together  in  my  car.   There  was  a  rule  that 
you  couldn't  take  any  German  marks  out  of  Germany.  A  lot  of  people 
were  trying  to  smuggle  them  out  in  tires.   We  stopped  at  the  border 
and  were  searched .   I  had  about  forty  marks ,  which  my  wife  had  put 
somewhere  on  me  as  change,  and  without  telling  me.   So  there  was  a 
great  deal  of  activity  about  that. 

Hughes:   It  all  came  out  all  right? 

Gerbode:   Eventually.  We  had  to  appear  before  kind  of  a  court  in  Munich  a 
few  days  later. 

Hughes:   You  were  allowed  to  go  on? 


23 


Gerbode:   Yes.   We  had  to  leave  the  money  and  to  pay  a  fine,  and  then  come 
back,  and  it  was  all  right.   But  Mrs.  Ophlils  was  so  indignant  with 
this  guy  later  in  Munich  that  he  finally  dropped  all  the  charges 
against  me.   She  was  such  an  aristocratic  woman,  who  spoke  perfect 
German.   She  just  alayed  him  verbally. 

Hughes:   You  were  lucky. 

Gerbode:  Oh,  lucky,  yes.  But  you  know,  they  took  her  off  and  searched  her 
completely.  They  made  her  take  her  clothes  off,  and  they  took  my 
wife  in  a  back  room  and  did  the  same. 

Hughes:   Why  were  they  so  concerned  about  the  marks  leaving  Germany? 
Gerbode:   They  wanted  to  have  everything  regulated  and  under  control. 

Hughes:   What  were  your  colleagues  in  the  institute  saying  about  the 
situation? 

Gerbode:   Periodically  they  would  say,  "Don't  you  think  that  Germany  is  much 

better  than  the  United  States?"  Little  things  like  that.   Or  they'd 
ask  me  if  I  wanted  to  go  to  one  of  these  indoctrinating  lectures. 
I  went  to  a  couple  of  them  where  they  were  talking  about  racial 
background.   This  was  when  they  were  talking  a  lot  about  Lebensraum 
and  about  the  people  in  East  Prussia  and  Poland  being  of  German 
extraction,  and  they  really  ought  to  be  with  the  German  government, 
and  "We  need  that:  land;  they  ought  to  be  with  us."  There  wasn't 
very  much  going  on  about  the  Jews  that  you  could  see  on  the  surface, 
although  there  was  an  awful  lot  going  on  beneath  the  surface,  I'm 
sure. 

Hughes:   But  you  weren't  really  aware  of  that? 

Gerbode:   Not  in  the  beginning.   But  after  I  was  there  about  six  or  seven 

months,  I  began  to  hear  about  Jewish  people  losing  their  property 
and  jobs. 


Hans  Borst 


Gerbode:   Professor  Borst  had  a  son  by  the  name  of  Hans.   He  was  a  charming 
young  man.   Then  he  was  only  about  fourteen  years  old.  [The  senior 
Borst]  began  to  worry  that  there  was  going  to  be  a  war.   We  began 
to  discuss  whether  I  would  take  Hans  back  with  me  to  the  United 
States.   I  said,  "Sure,  I'll  take  him." 


24 


Gerbode:   This  was  his  only  son.   He'd  had  a  daughter  who'd  died  of 

tuberculosis,  and  this  was  the  child  of  a  second  marriage.   He'd 
married  a  beautiful  Hungarian  woman  who  is  still  living  in  Munich, 
and  they  had  this  son  Hans.   Hans  got  all  the  beauty  of  his  mother 
and  all  the  savoir  faire  and  intelligence  of  his  father.   But 
finally  the  professor  decided  that  since  he'd  waited  so  long  for  a 
son,  he  just  couldn't  part  with  him.   So  we  decided  that  we  wouldn't 
take  him  to  America. 

Anyway,  the  story  of  Hans  goes  on  and  on.   It's  still  going  on, 
incidentally.  Whether  you're  interested  in  that  now — 

Hughes:   Why  don't  you  tell  me. 

Gerbode:  The  war  went  on,  and  a  couple  of  years  later,  Hans  was  old  enough 
to  be  drafted  into  the  army,  so  they  put  him  in  the  paratroopers. 
He  was  such  a  strong  fellow  and  a  great  skier,  he  went  into  a 
parachute  outfit  in  Germany.   They  were  fighting  the  English  toward 
the  end  of  the  war,  and  his  whole  unit  was  captured.   Then  he  was 
sent  to  an  English  prisoner  of  war  camp,  where  he  learned  how  to 
talk  English  perfectly. 

After  the  war  was  over,  he  decided  that  he  wanted  to  become 
a  doctor,  so  he  went  to  the  university,  and  then  he  decided  that 
he'd  like  to  come  to  this  country  to  go  to  medical  school.   So  I 
tried  to  get  him  into  Stanford  Medical  School ,  but  the  dean 
wouldn't  think  of  taking  a  foreigner  into  medical  school.   He  was 
a  very  strange  man  in  that  respect,  not  very  big  minded  about  such 
matters.   However,  another  friend  of  mine  by  the  name  of  Harry 
Beecher,  who  was  professor  of  anesthesiology  at  Harvard,  and  I  got 
him  into  Harvard  Medical  School.   So  Hans  then  went  through  medical 
school  at  Harvard,  and  was  married  to  a  girl  with  some  Jewish  blood. 
He  came  out  with  me  for  an  internship  here ,  and  I  got  him 
interested  in  pulmonary  physiology.   He  did  some  work  studying  lungs 
and  later  went  back  to  the  public  health  department  at  Harvard 
and  took  a  fellowship  in  physiology,  continuing  his  work  that  he 
had  started  here.   Then  he  got  interested  in  running  a  heart-lung 
machine,  because  he  was  very  good  at  physiology,  so  he  started 
doing  some  work  on  extracorporeal  circulation  there.   Finally  he 
went  back  to  Germany  and  got  a  job  with  a  professor  by  the  name  of 
Rudolf  Zenker,  who  was  then  professor  of  surgery  at  Munich.   Later 
on,  when  heart  surgery  began  to  become  a  serious  objective,  [Zenker] 
put  him  on  running  the  heart-lung  machine.   This  continued  for 
several  years,  until  he  was  really  kind  of  a  super  technician  for 
the  unit.   The  reason  [Zenker]  kept  him  there  was  because  he  was  so 
good  at  it.   But  that  wasn't  the  way  to  become  a  surgeon  or  a 
professor. 


25 


Gerbode:   I  went  back  to  Munich  several  times  after  the  war  and  kept  in 

touch  with  Hans.   I  finally  went  to  Zenker  and  said,  "You  can't 
do  this  to  him.   You've  got  to  get  somebody  else  to  run  that 
machine  and  put  him  in  the  regular  training  program  in  surgery, 
starting  with  general  surgery  and  going  through  the  whole  business." 
So  he  did.   He  stayed  on  in  the  department  there  in  Munich  for 
quite  a  while  and  divorced  his  wife.   I  won't  go  into  why. 
Subsequently  he  got  married  to  a  charming  girl  and  had  another 
daughter.   He  has  a  son  by  his  first  wife,  who  is  a  very  fine 
student,  very  brilliant.   He'll  undoubtedly  be  a  professor  one  day. 
When  they  started  a  whole  new  medical  school  in  Hanover,  [Hans] 
applied  for  the  job  and  got  it.   So  he's  now  the  professor  of 
surgery  at  Hanover  and  one  of  the  strongest  academic  surgeons  in 
Germany.   Big,  handsome,  wonderful  guy.   Speaks  perfect  English. 
Very  intelligent.   Reads  a  lot.   I  see  him  almost  every  year.   When 
he  comes  out  here,  he  stays  with  me,  and  I  see  him  at  various 
meetings. 

So  anyway,  the  year  went  by  over  there.   I  managed  to  stay  out 
of  trouble,  and  I  think  I  learned  quite  a  bit  about  pathology.   My 
wife  had  a  grand  time.   She  loved  shopping  with  the  German  hausfraus. 

Hughes:  Were  you  being  singled  out  as  a  foreigner? 

Gerbode:  Yes. 

Hughes:  You'd  be  particularly  watched? 

Gerbode:  Oh,   yes. 

Hughes:  What  were  they  worried  about? 

Gerbode:   I  guess  they  were  afraid  that  we  might  take  money  out  of  the  country 
or  help  people  who  were  under  surveillance.   As  an  example,  our 
cook's  husband  was  a  writer  of  some  kind  or  other,  and  he  was 
arrested  because  he  wrote  an  article  against  the  Nazis.   He  was 
put  in  a  concentration  camp.   He  stayed  there  for  about  six  months, 
and  they  finally  let  him  out  if  he  agreed  to  write  articles  for 
the  Nazis.   They  decided  he  might  as  well  do  that  rather  than  die. 
So  he  came  back  to  the  house.   He'd  lost  all  his  teeth.   He  looked 
like  a  walking  cadaver. 

Hughes:    So  you  were  beginning  to — 

Gerbode:   Get  the  picture.   Then  another  family  whom  we  met  there,  a  Jewish 
family,  an  ophthalmologist,  wanted  to  get  out,  too,  because  he 
could  see  that  his  job  in  the  university  was  going  to  be  terminated 
before  long,  and  he  might  even  be  shipped  off.   So  we  helped  them 
get  out  of  the  country,  and  I  got  him  a  job  here  at  Stanford. 


26 


Hughes:   How  did  you  manage  that  without  the  German  authorities  knowing? 

Gerbode:   I  think  at  that  time  they  were  able  to  get  out.   If  they  didn't 

have  a  bad  record,  they  let  them  emigrate.   So  that's  what  they  did. 
She's  an  artist.   She's  still  living.  He  died  of  cancer  of  the 
kidney  after  a  while.   I  have  at  least  twelve  of  her  paintings  at 
home.   She  still  lives  here.   She  married  a  publisher,  Ed  Grabhorn, 
in  San  Francisco.  He  subsequently  died.   She  goes  on  painting. 

Hughes:   What  was  his  name? 
Gerbode:   Sam  Engel. 

Hughes:   Was  that  the  beginning  of  the  persecution  of  the  Jews,  as  far  as 
you  knew? 

Gerbode:  No.  When  we  were  there,  they  began  to  take  them  out  of  positions  of 
importance,  demote  them,  or  actually  encourage  some  of  them  to 
leave  the  country.  Those  who  were  active,  I  guess,  were  simply 
locked  up.   You  never  knew  about  them.   But  I  knew  about  the 
concentration  camp  outside  of  Munich.   I  knew  it  was  there,  because 
my  cook's  husband  told  me  all  about  it. 

Hughes:   Which  camp? 
Gerbode:   This  was  Dachau. 

I  didn't  write  any  papers  when  I  was  in  Germany.   I  certainly 
learned  that  if  a  political  group  gets  control  of  every  part  of 
the  government,  they  can  be  pretty  terrifying. 

Hughes:  Were  you  specializing  in  any  particular  form  of  pathology? 

Gerbode:  No,  just  general  pathology. 

Hughes:  What  about  Borst  himself?  What  was  his  area  of  interest? 

Gerbode:  Tumors.  He  wrote  a  very  good  book  on  tumors. 

Hughes:  He  was  an  MD? 

Gerbode:  Yes. 

Hughes:  Did  he  practice  medicine? 


27 


Gerbode: 


Hughes : 
Gerbode; 


Hughes: 
Gerbode; 

Hughes : 
Gerbode: 


Only  pathology.   He  was  a  full-time  pathologist  and  a  very  famous 
person.   Because  of  his  work  on  tumors,  he  was  an  international 
scientist,  you  might  say.   Another  part  of  the  Borst  story  is  that 
he  had  a  little  place  in  the  mountains  where  he  used  to  go  on 
weekends.   The  head  deiner  in  the  institute  would  drive  him  up 
there.   He  invited  me  up  a  couple  of  times  to  this  lovely  little 
place  in  the  mountains  outside  of  Munich.   After  the  war,  his  car 
broke  down.   He  was  standing  on  the  highway  while  a  man  was  fixing 
it,  and  an  American  truck  came  along  and  hit  and  killed  him. 

Does  that  take  care  of  the  University  of  Munich? 

I  think  the  other  thing  that  I  enjoyed  very  much  there  in  Munich 
was  the  museums.  Munich  is  an  art  center,  always  has  been,  for 
generations,  I  guess.   Hitler,  wanting  to  show  people  that  he  had 
an  interest  in  art,  built  a  whole  new  museum,  with  big  pillars  in 
front,  advertising  the  fact  that  the  Nazi  party  was  for  culture. 
It's  still  used  as  a  museum  now,  but  nobody  knows  that  Hitler  built 
it.   I  guess  they  all  know,  but  they  don't  say  anything  about  it. 


Was  it  very  selective  in  the  art  that  they  exhibited? 

Yes.   The  Nazis  threw  out  all  the  modern  paintings, 
classical  and  propaganda  paintings. 


They  only  kept 


Did  Munich  perk  your  interest  in  the  arts,  do  you  think? 

I  think  it  probably  did.   I  certainly  paid  more  attention  to  it 
there  than  ever  before.   I  also  enjoyed  a  lot  of  the  people,  their 
lifestyle.   They  like  skiing,  they  like  music.   The  opera  was  a 
great  feature  there  and  still  is.  The  opera  house  in  Munich  is 
one  of  the  great  opera  houses  in  the  world.   It's  the  first  one 
I'd  ever  seen  where  the  stage  could  go  up  and  down  and  turn.   It 
was  almost  totally  destroyed  during  the  war.   They  rebuilt  it  and 
made  it  bigger,  but  exactly  in  the  same  form.   It's  really  quite 
beautiful. 


Surgical  Resident  and  Instructor  in  Surgery  at  Stanford,  1937-1942 

Gerbode:   After  I  returned  to  California,  Dr.  Holman  took  me  into  the 

department  of  surgery  as  an  assistant  resident  on  the  lowest  level. 
So  I  started  like  anyone  else,  learning  how  to  be  a  surgeon. 


Hughes:   Did  you  ever  have  any  thoughts  of  going  anywhere  else? 


28 


Gerbode:   Yes,  I  thought  about  it,  but  not  very  long,  because  I  like 

California  so  much.   This  problem  has  come  up  many  times,  about 
my  leaving  San  Francisco  and  going  elsewhere.   I  didn't  want  to 
go  anywhere  else.   If  anyone  says,  "You've  had  a  very  successful 
career,"  I  say,  "Yes,  and  I  didn't  even  go  to  Harvard."  [laughter] 

Hughes:   We  should  talk  about  the  fact  that  you  are  West  Coast.  My  under 
standing  is  that  most  of  the  early  work  in  cardiac  surgery  was 
pretty  much  East  Coast  oriented. 

Gerbode:  The  first  things  were  all  East  Coast.  There's  no  question  about  it. 
The  first  patent  ductus  and  first  coarctation  were  done  by  [Robert 
Edward]  Gross  in  Boston.   The  first  mitral  valve  operations  were 
done  by  [Charles  Philamore]  Bailey  in  Philadelphia  and  [Dwight] 
Harken  in  Boston.   I  can  assure  you  that  we  followed  very  quickly 
thereafter,  as  did  others. 

Hughes:    Is  that  just  the  fact  that  these  were  traditional  medical  centers, 
and  the  ones  in  the  West  were  new? 

Gerbode:   Yes,  I  think  also  the  fact  that  they  really  had  bigger  and  more 
elaborate  departments.   The  East  really  held  the  leadership  in 
medicine  for  quite  a  while.   They're  still  great,  of  course,  but 
there  are  other  smaller  places  that  have  done  exceedingly  well, 
even  though  they  aren't  in  the  so-called  mainstream  of  American 
medicine. 

Hughes:   Was  Stanford  medicine  always  research  oriented? 

Gerbode:  No,  it  wasn't,  [although]  it  had  good  research  going.   [There  was] 
a  big  research  building  which  is  still  up  the  street,  called  the 
Stern  Laboratory.   There  were  people  on  the  faculty  who  were  always 
busy  with  one  kind  or  another  of  research,  and  some  basic  discoveries 
were  made  in  the  medical  school.   But  overall,  I  think  the  emphasis 
was  on  good  clinical  medicine. 

So  anyway,  I  came  back  as  an  assistant  resident  and  had  to 
learn  how  to  be  a  surgeon.   You  learn  by  assisting,  working  up  the 
cases.   I  went  right  back  to  the  laboratory  again,  though. 

Hughes:   Was  this  Holman's  laboratory? 

Gerbode:  This  was  mainly  Reichert  at  that  time.   I  watched  what  Holman  was 
doing  and  sometimes  would  help,  but  it  was  Reichert  mainly  who  was 
doing  most  of  the  laboratory  work. 

Hughes:   Holman  was  mainly  a  surgeon. 


29 


Early  Cardiovascular  Surgery 


Gerbode:   Yes.   Reichert  was,  too,  but  Holman  was  running  the  department.   He 
had  more  administrative  work  to  do.   During  those  few  years  we 
began  to  do  more  major  vessel  cases.   Then  later  on  we  began  to  do 
mitral  cases  and  patent  ductus  and  coarctations.   These  were  some 
of  the  early  operations.   I  was  able  to  assist  on  them,  and  later 
on  able  to  catch  one  every  once  in  a  while  for  myself. 

Hughes:   You  were  allowed  to  do  these  big  operations? 
Gerbode:   Later  on,  after  I  was  there  for  two  or  three  years. 
Hughes:   What  was  the  success  rate  in  those  early  days? 

Gerbode:   I  don't  know  that  we  ever  lost  a  patent  ductus.   I  think  I  only  lost 
one  coarctation  out  of  a  lot  of  them.  The  mortality  rate  for 
mitral  operations  was  about  5  percent,  something  like  that.   But 
they  weren't  open;  they  were  closed  mitral  operations.   They  were 
all  done  with  instruments  or  an  index  finger  in  the  heart. 

Hughes:   The  valvulotome? 

Gerbode :   Yes .   I  devised  an  instrument  for  cracking  the  valve ,  too ,  which 
we  used  in  many  cases.   You'd  put  it  in  through  the  apex  of  the 
heart,  and  then  you'd  feel  it  in  the  atrium  and  then  get  it  in 
the  valve  and  open  it.   That  would  split  the  valve  so  it  could 
move  again. 

Hughes:   Does  it  have  a  name? 

Gerbode:   They  called  it  a  mitral  valve  dilator.   It's  still  sold,  as  a 
matter  of  fact. 

Hughes:   Did  you  patent  it? 

Gerbode:   No. 

Hughes:   The  name  of  the  game  then  was  to  operate  as  quickly  as  you  could? 

Gerbode:   No,  the  name  of  the  game  by  then  was  to  operate  cautiously  and 

selectively.   For  example,  the  first  criteria  we  set  up  for  mitral 
valve  operations  were  that  the  patients  shouldn't  be  over  forty-five 
years  of  age,  they  shouldn't  have  this  and  shouldn't  have  that. 

Hughes:   Was  that  social  usefulness,  or  was  that  just  chances  of  survival? 


30 


Gerbode:   Chances  of  survival.  We  thought  if  they  had  atrial  fibrillation, 
which  is  very  common,  that  it  was  too  dangerous.   But  later  on  we 
found  that  90  percent  of  the  patients  we  were  operating  upon  had 
atrial  fibrillation.   It  was  just  something  that  we  had  thought 
of  as  being  the  safest  thing  to  do  in  the  beginning. 

Hughes:   You  mean  in  the  normal  course  of  events  they  would  incur 

fibrillation,  not  just  when  they  were  being  operated  upon. 

Gerbode:   That's  part  of  their  disease. 

[interruption] 
Gerbode:   It  was  picked  up. 

Hughes:   It  was  picked  up? 

Gerbode:  Yes,  you  could  make  the  diagnosis  easily.   But  they  thought  that 
maybe  it  was  too  dangerous  to  operate  upon  people  who  had  it. 

Hughes:   But  you  found  that  that  wasn't  the  case. 
Gerbode:  Later  on.   It  wasn't  the  case  at  all. 

Hughes:   It  seems  to  me  in  any  surgery  there's  always  that  very  fine  line 

of  decision  in  regards  to  choosing  patients  that  are  seriously  ill. 
How  ill  should  they  be  for  an  [operation]  that  is  still  experimental? 

Gerbode:  You  proceed  cautiously,  and  you  keep  operating  upon  something 

that's  a  little  more  difficult.  Then  if  you  begin  to  be  successful 
in  doing  it,  then  that  encourages  you  to  take  on  more.  In  the  end, 
you  operate  upon  very  sick  people. 

Hughes:   What  was  the  rest  of  the  medical  profession  saying  about  these 
operations? 

Gerbode:  The  cardiologists  were  very  conservative  about  mitral  surgery. 

Hughes:  Was  it  Holman  who  was  doing  the  heart  surgery? 

Gerbode:  Yes,  Holman  was. 

Hughes:  Reichert  didn't — ? 

Gerbode:  No,  he  didn't. 

Hughes:  Can  you  describe  how  an  operation  for  patent  ductus  was  done? 


31 


Gerbode:   [Now]  it's  done  routinely  by  residents.   A  patent  ductus  is  a 
connection  between  the  pulmonary  artery  and  the  aorta.   [The 
ductus   arteriosus  is]  a  tube  which  is  present  in  the  embryo,  and 
that's  the  way  the  blood  gets  from  the  mother  into  the  child. 
Within  a  few  weeks  after  birth,  the  duct  closes.   If  it  doesn't 
close,  then  it  produces  a  physiological  change  which  is  not  very 
good  for  the  patient  and  can  produce  heart  failure. 

The  operation  consists  of  a  left  thoracotomy,  exposing  the 
connection  which  is  right  near  the  heart.   Initially  it  was  just 
tied  with  a  couple  of  sutures.   But  later  on  there  were  perhaps 
5  percent  recurrences  when  this  was  done,  so  then  surgeons  began 
to  divide  it,  by  first  putting  clamps  on  it,  then  cutting  between 
them  and  sewing  each  end. 

Hughes:   The  actual  suturing  had  to  be  very  quick,  didn't  it? 

Gerbode:   No.   The  ductus  doesn't  do  much  to  the  rest  of  the  circulation  when 
it's  clamped  off. 

Hughes:   You  weren't  actually  operating  on  the  heart  itself? 

Gerbode:   Not  in  those  days.   It  wasn't  until  1953,  more  or  less,  that  we 
started  on  the  heart . 


Prewar  Cardiovascular  Research 


Hughes:   Were  you  doing  research  during  this  time  as  an  assistant  resident? 
Gerbode:   Yes,  I  always  had  a  little  something  going. 
Hughes:   What  was  going  in  1937-38? 

Gerbode:   I  was  trying  various  things  on  the  heart,  producing  conditions  in 
an  experimental  animal  which  were  like  those  found  in  the  human, 
and  then  measuring  them  and  seeing  what  we  could  learn  from  them. 

Hughes:   What  types  of  things? 

Gerbode:   Experimental  hypertrophy  of  the  heart,  for  example,  making  the 
heart  muscle  bigger  [on]  one  side  or  the  other. 

Hughes:    I  know  there  were  some  postwar  papers  about  ligating  one  of  the 
great  vessels  in  puppies. 


32 


Gerbode:   That  was  the  kind  of  work. 
Hughes:   Did  that  start  before  the  war? 

Gerbode:  No,  this  was  after  the  war,  when  I  came  back.   Then  I  wanted  to 
produce  a  cyanotic  animal,  which  had  only  been  done  once  before 
successfully.   So  I  finally  was  able  to  produce  a  small  collection 
of  blue  animals,  because  we  were  interested  in  blue  babies  by  that 
time.   I  finally  published  that  work.   It  didn't  seem  terribly 
important,  but  it  was  important  for  me  to  be  able  to  do  it.   But 
it's  a  funny  thing  that  when  the  Swedes  gave  me  an  honorary  degree* 
and  I  stood  up  and  listened  to  the  eulogy  which  described  this 
honorary  degree,  they  mentioned  this  work.   They  dug  it  out  and 
said  that's  important.   I  didn't  think  it  was  so  important. 

Hughes:   Did  other  people  think  it  was  important  at  the  time? 

Gerbode:   I  don't  think  so. 

Hughes:   How  did  you  produce  cyanosis? 

Gerbode:   I  switched  the  inferior  vena  cava  from  the  right  side  of  the  heart 
to  the  left  side  of  the  heart. 

Hughes:   What  happened  between  1938  and  1942  when  you  went  off  .:o  war?  You 
were  still  an  assistant  resident  for  that  whole  period? 

Gerbode:   I'd  finished  my  residency,  and  I  was  already  an  instructor  on  the 
faculty. 

Hughes:   That's  right.   In  fact,  according  to  your  curriculum  vitae,  from 
1937  to  1938  you  were  an  assistant  resident  in  surgery  as  well  as 
an  assistant  in  surgical  research. 

Gerbode:   That's  because  I  was  always  up  there  doing  something  in  the 
laboratory. 

Hughes:   Then  from  1938  to  1939  you  were  an  assistant  resident  in  surgery, 
1939  to  1940  a  resident  in  surgery. 

Gerbode:  Yes,  the  chief  resident. 

Hughes:   Did  that  mean  an  increase  in  operating  opportunities? 


*Dr.  Gerbode  received  the  M.D.  degree,  honoris  causa,  from  the 
University  of  Uppsala  in  1965. 


33 


Gerbode:   Oh  yes,  because  when  you're  a  chief  resident,  you  do  all  the 

operations  on  the  clinic  service,  unless  you  think  you  shouldn't 
be  doing  it  by  yourself.   Or  the  chief  would  help  you  do  a 
difficult  case. 

Hughes:   But  you  were  expected  to  be  able  to  do  all  of  the  cases? 

Gerbode:   Expected  to  do  most  of  them. 

Hughes:   What  about  these  very  innovative  ones? 

Gerbode:   If  you  were  doing  an  innovative  one,  you'd  usually  have  one  of 
the  professors  scrub  with  you. 

Hughes:   Were  you  considered  a  cardiac  surgeon  at  this  time  or  a  general 
surgeon? 

Gerbode:   General  surgeon.   At  that  time,  there  wasn't  really  a  specialty  of 
thoracic  surgery.   It  wasn't  until  after  the  war  that  they  began 
to  recognize  the  subspecialties. 

Hughes:   Because  you  and  Holman  were  particularly  interested  in  the  heart, 
was  Stanford  developing  a  reputation  for  heart  surgery? 

Gerbode:   I  think  Holman  really  developed  a  reputation  for  being  interested 
in  circulation  and  great  vessel,  not  heart. 


Premonitions  of  World  War  II 


Hughes:   The  next  step  is  the  war. 


Gerbode: 


Hughes : 


Gerbode: 


Having  been  in  Germany  before  the  war  started,  I  could  see  that 
was  coming.   One  taxi  cab  driver  there  said,  "One  day  Austria  will 
go.   The  next  day  we'll  take  Poland  just  like  that."  They'd 
figured  it  all  out.   Austria  did  fall  while  we  were  there,  and 
Poland  came  not  too  long  afterwards. 

But  that  was  not  the  thinking  in  1937  when  you  returned  to  this 
country,  was  it? 

People  had  their  heads  buried  in  the  ground.   When  I  told  them  what 
I'd  seen  them  doing  over  there,  they  thought  I  was  praising  them. 
I  said,  "I'm  not  praising  them.   I'm  merely  telling  you  what  I  saw." 


34 


Gerbode:  The  same  thing  happened  to  Lindbergh,  whom  we  met  at  a  reception 
in  Berlin.   He'd  seen  the  preparations  for  war.   He  came  back  and 
told  people  about  it,  and  they  accused  him  of  praising  the  Germans. 

Hughes:   That  must  have  been  frustrating  for  you,  seeing  the  writing  on 
the  wall. 

Gerbode:  After  a  while  I  just  decided  I  wouldn't  say  anything  about  it.   But 
[I]  saw  this  army  actually  drill  down  to  the  bone,  and  saw  their 
tanks,  and  how  they  were  teaching  all  these  youngsters  to  drive 
jeeps  and  cars  and  everything.   You  could  see  them  in  the  fields 
learning  how  to  go  through  mine  fields  and  through  barbed  wire. 
They  weren't  doing  that  for  football. 

Hughes:   Did  you  also  feel  that  the  United  States  would  have  to  become 
involved? 

Gerbode:   Eventually,  sure. 


35 


II   SURGEON,  U.S.  ARMY  MEDICAL  CORPS,  1942-1945 
[Interview  2:   August  1,  1983 ]## 


Decision  to  Go  to  War 

Gerbode:   [Anyone]  around  the  time  of  1938  to  '42,  would  wonder  whether  or 
not  we  were  going  to  get  into  this  war  which  Hitler  had  started. 
But  having  been  there  [Germany]  for  practically  a  year  and  having 
seen  the  preparations  and  having  heard  what  the  Nazi  ideology  was 
turning  out,  it  was  quite  apparent  [to  me]  that  we  would  have  to 
get  into  the  war  eventually,  because  there  would  be  no  stopping 
Hitlerism  if  he  won  the  war  in  Europe.   The  next  thing  would  be 
South  America,  and  then  Lord  knows  what  else. 

So  I  decided  pretty  early  that  I  would  have  to  get  into  it.   I 
suppose  in  my  position  I  could  have  stayed  home,  stayed  in  the  medical 
school  and  taught  like  some  of  the  men  did.   It  was  necessary  for 
some  of  them  to  stay  home  to  keep  the  medical  school  going.   Also 
having  a  rather  large  family,  I  could  have  used  that  as  an  excuse 
for  staying  home,  too.   But  I  wanted  to  be  counted.   My  thoughts 
came  to  a  head  in  New  York  when  I  heard  a  lecture  by  a  very 
distinguished  English  surgeon  by  the  name  of  Sir  Gordon  Gordon-Taylor. 
He  was  a  very  fine,  beautiful  gentleman.   He  came  to  New  York  and 
showed  pictures  of  the  bombing  in  London  and  the  problems  the  English 
were  having  with  fighting  the  Germans.   His  mission  was,  of  course, 
to  get  Americans  more  interested  in  fighting  Hitlerism. 

I  also  was  very  impressed  with  The  Life  of  Harvey  Gushing, 
which  is  a  biography  written  by  one  of  Harvey  Gushing 's  students, 
[John  Fulton].   In  it  it  was  quite  apparent  that  an  affiliated 
team  of  doctors,  in  that  instance  from  Harvard,  was  able  to 
accomplish  a  good  deal  in  a  war  effort. 


36 


Preparations  in  the  U.S. 


Gerbode:  At  this  time  the  Stanford  medical  faculty  here  was  putting  together 
two  teams,  one  a  navy  team,  the  other  army.   This  subsequently 
developed  into  a  rather  good-sized  effort  of  Stanford  physicians 
and  surgeons. 

Hughes:   Was  that  a  spontaneous  effort? 

Gerbode:  Yes.   I  think  they  felt  they  wanted  to  get  into  the  war  and  get 
in  as  a  group.   The  army  group  was  brought  together  by  Stanford 
doctors  mainly  from  the  San  Francisco  General  Hospital.   I  could 
have,  I  suppose,  joined  either  of  these  two  efforts,  but  I  decided 
that,  from  what  I  had  read,  it  seemed  to  me  that  a  surgeon  would 
have  more  to  do  in  the  army  than  in  the  navy,  and  I  wanted  to  be 
busy  and  to  participate.   So  I  joined  the  Stanford  army  unit. 

Hughes:   Were  you  thinking  of  yourself  as  a  thoracic  surgeon? 
Gerbode:   I  was  trained  as  a  general  and  thoracic  surgeon  at  that  time. 

Hughes:   So  you  were  thinking  still  in  terms  of  general  surgery  in  terms  of 
the  war? 

Gerbode:   I  was  just  thinking  in  terms  of  getting  into  the  war  and  being  a 
surgeon.   So  we  went  into  the  reserve  and  waited  until  we  were 
called.   The  call  came  in  early  1942.   Something  like  forty-five 
doctors  and  fifty-two  nurses  had  joined  the  reserve  unit.   They 
were  all  called  together  at  one  time.   I  was  lucky,  because  I  had 
finished  my  training  and  had  enough  experience  so  that  I  was  given 
a  major's  commission,  which  was  quite  a  good  commission  at  that 
time. 

We  were  sent  up  to  Ft.  Lewis,  Washington,  where  we  went  into 
basic  training  for  about  six  weeks,  had  to  do  all  the  same  things 
as  the  infantry.   Several  of  the  doctors  who  were  not  very 
physically  fit  had  trouble  coping  with  this  training.   I  must  say 
that  I  didn't  do  terribly  well,  but  I  didn't  fall  by  the  wayside 
anyway . 

Then  we  came  down  to  Ft.  Ord,  near  Monterey,  and  there  we  were 
supposed  to  get  ready  for  some  sort  of  an  amphibious  landing.   They 
shipped  out  the  complete  equipment  for  an  evacuation  hospital. 
The  equipment  when  we  opened  the  boxes  was  World  War  I  equipment. 
It  was  just  terrible.   I  was  given  the  job  to  sort  this  stuff  out 
and  package  it  so  it  could  be  landed  somewhere  and  put  together  again 


37 


Gerbode:   as  a  complete  hospital.   I  was  glad  to  do  this,  because  otherwise 
there  wasn't  much  else  to  do  at  Ft.  Ord  except  hike  and  eat  and 
complain  about  the  army.   [laughter] 

So  I  set  up  really  what  amounted  to  a  construction  unit, 
making  boxes  and  things  to  put  all  this  stuff  together.   I  kept 
asking  the  commanding  general  down  there  for  more  and  more  material, 
and  once  he  got  so  fed  up  with  me  that  he  said  to  the  man  on  the 
phone,  "God  damn  it,  don't  give  him  what  he  wants.   Give  him  what  he 
requires."   [laughter]   Well,  I  felt  that  I  did  require  this  stuff, 
and  we  got  it  finally. 

The  unit  was  put  together  just  before  the  Dieppe  raid.   I 
think  that  the  idea  was  that  we  were  going  to  go  to  England  and 
then  follow  the  Dieppe  raid  into  Normandy  if  it  was  successful.   But, 
as  you  may  recall,  the  Dieppe  raid  failed.   It  was  kind  of  a 
disaster.   So  instead  of  going  there,  we  were  sent  to  Virginia  for 
further  waiting  to  see  what  would  happen  next.   Meanwhile  all  that 
equipment  which  we  had  put  together  had  gone  to  England,  which  was 
lucky,  because  it  wasn't  any  good  anyway. 

Before  that  we  had  a  very  brief  period  in  New  Jersey  where 
we  were  supposed  to  be  staging  for  the  leap  to  England,  but  when 
the  Dieppe  raid  failed,  we  were  moved  down  to  Farmville,  Virginia. 
There  we  put  together  another  hospital,  but  this  time  with  more 
modern  equipment.   We  had  the  experience,  so  it  was  easier  to  do  it 
the  second  time. 

Hughes:   This  was  a  complete  hospital? 

Gerbode:   A  complete  hospital,  tents  right  down  to  the  bedpans.   Everything. 
It  came  in  boxes,  and  then  we  had  to  sort  it  out  and  put  it 
together.   We  would  have  an  operating  room  set  of  boxes  and  an 
intensive  care  room  set  of  boxes  and  so  forth.   Why  the  commanding 
officer  put  me  in  charge  of  this,  I  don't  know,  but  later  on  I 
think  he  had  a  feeling  that  I  had  logistic  ability.   In  any  event, 
I  didn't  mind  doing  it. 

To  do  this,  I  found  a  couple  of  very  fine  noncommissioned 
officers  to  help.   One  was  a  fellow  by  the  name  of  Carson,  who  was 
a  very  fine  carpenter.   The  other  was  a  fellow  by  the  name  of 
Querhammer,  who  was  a  farmboy  from  the  Middle  West.  They  turned  out 
to  be  excellent  workers  and  very  enthusiastic  about  the  project,  and 
really,  with  guidance,  put  it  together.   So  then  we  had  another 
complete  hospital.   We  stayed  there  until  the  army  decided  where 
we  were  going  to  go. 


38 


Casablanca 


Gerbode:  As  it  turned  out,  some  time  later  we  were  sent  to  Africa  and  landed 
in  Casablanca.   It  was  a  gigantic  convoy  across  the  Atlantic,  the 
second  big  convoy  to  go  into  Morocco.  We  landed  in  Casablanca 
a  day  before  Christmas  [1942].  You  think  of  that  part  of  Africa 
as  being  warm  all  the  time,  but  in  the  winter  it's  very  cold.   Our 
equipment  was  scattered  all  up  and  down  the  coast .   It  took  weeks 
to  get  it  together  again.  We  had  no  tents,  for  example,  when  we 
landed.  We  were  put  in  a  field  next  to  an  Arab  cemetery.   We 
borrowed  some  hay  and  a  few  tarpaulins  from  another  army  unit .   They 
were  given  to  us  very  reluctantly,  but  we  improvised  some  sort  of 
a  tent  to  cover  us  during  the  night,  and  slept  on  hay  until  we 
could  find  some  of  our  tents,  which  took  a  couple  of  weeks,  really, 
to  get  organized. 

Hughes:   There  were  a  lot  of  other  American  units  in  the  area? 

Gerbode:  A  little  bit  later  on  [General  George]  Patton  arrived  with  his  tank 
division,  and  they  were  billeted  right  across  the  road  from  us. 
Patton,  of  course,  was  a  very  amusing  but  very  good  general.   I 
think  he  was  a  fine  general  in  the  field,  a  terrible  general  at 
headquarters.   He  issued  an  order,  for  example,  when  we  were  there, 
that  the  knit  wool  cap ,  which  went  under  the  helmet ,  should  not  be 
worn  without  the  helmet.  We  were  bombed  nearby  by  some  German 
planes  a  few  nights  before,  so  we  were  issued  an  order  to  dig  slit 
trenches  in  case  they  came  back  again.  One  of  our  captains,  who  has 
since  died,  was  shoveling  out  there  with  a  knit  wool  cap  on  when 
Patton  came  by.   He  stopped  his  jeep  and  got  out  with  these  big 
revolvers  on  each  side,  stomped  over  and  said  to  this  fellow,  "Stand 
up.  Are  you  an  officer  or  not  an  officer?"  "Yes,  Sir,  I'm  an 
officer."  "What  have  you  got  on  your  head?"  "I've  got  a  wool  cap." 
"Take  that  thing  off,  and  in  the  future  behave  like  an  officer."  He 
was  so  furious  that  he  went  through  his  own  billet  across  the  road 
and  bawled  everybody  out  everywhere  he  went.   He  bawled  them  out 
for  hanging  laundry  outside  their  puptents  and  everything  else.   We 
were  near  him  several  times. 

In  any  event,  we  stayed  in  Casablanca  for  quite  a  while  and 
took  care  of  troops  or  injuries  which  were  evacuated  from  Algeria 
and  northern  Africa.  A  lot  of  Germans  had  been  wounded  previously 
in  the  fighting  in  Russia,  and  they'd  come  in  with  old  shrapnel 
wounds  and  old  pieces  of  metal  in  their  bodies,  in  addition  to  the 
new  metal.   A  rather  sorry  lot  of  soldiers,  I  must  say. 


39 


Gerbode:   We  set  up  a  very  good  tent  hospital  and  realized  for  the  first 
time  that  you  could  do  very  good  surgery  in  a  tent  hospital. 

Hughes:   Had  you  worked  with  most  of  this  team  before? 

Gerbode:   No,  I  hadn't.   We  were  all  from  around  here.   There  were  several 
men  from  the  University  of  California.   But  they  were  all  highly 
trained.   They  were  all  residents  and  had  good  training  in  surgery. 
Carl  Matthewson,  who  was  the  chief  surgeon,  was  particularly  good 
because  he  had  had  special  training  in  the  treating  of  fractures. 
Since  so  many  of  the  injured  had  fractured  bones,  it  was  very 
useful  to  have  him  establish  methods  of  treatment  for  the  unit. 

Hughes:   Were  you  doing  vascular  surgery? 

Gerbode:   We  did  everything.   Anything  that  was  on  the  table,  we  did,  including 
brain  surgery.   I  did  brain  surgery  and  spinal  cord  surgery.   But 
we  weren't  doing  very  much  reconstructive  vascular  surgery  at  that 
time.   That  came  later  on  in  the  war.   In  retrospect,  of  course,  we 
were  not  very  quick  to  realize  that  a  lot  of  this  could  be  done. 

Hughes:   When  you  say  that,  are  you  thinking  in  terms  of  grafts? 

Gerdode:   Grafts  and  repairing  arteries,  and  using  vein  grafts  to  insert  for 
deficits  in  an  artery. 

Hughes:   Not  too  much  of  that  had  been  done  anywhere . 

Gerbode:   No,  that's  right.   It  was  really  developed  at  that  time.   But  we 
were  kind  of  silly  not  to  think  of  it,  you  know. 

Hughes:   Do  you  think  the  war  gave  an  impetus  to  vascular  surgery? 

Gerbode:   Oh,  yes.   But  actually,  vascular  surgery  in  the  front  areas  really 
was  developed  in  the  Korean  War. 

Hughes:   That  late? 

Gerbode:   Quite  a  bit  later.   Some  repair  work  was  done  in  old  injuries  in 
base  hospitals  after  they  had  been  evacuated  from  the  front. 


40 


Andrew  Peatroscka 


Gerbode:  Anyway,  long  before  going  to  Africa,  I  had  once  been  to  Poland  to 
a  little  village  called  Druskininka.  My  wife  and  I  went  there  to 
visit  a  classmate  of  hers.   That's  a  very  interesting  part  of  the 
world ,  because  it  had  been  overrun  by  Germans  and  Russians  in 
several  wars  before,  and  there  were  a  lot  of  old  houses  with  bullet 
holes  in  them,  and  so  forth.   It  was  sort  of  a  haven  for  Jewish 
people.  This  particular  family  we  visited  were  not  Jewish.   They 
were  Polish  and  had  a  violent  history,  as  a  matter  of  fact.   The 
mother  of  the  girl  whom  my  wife  had  gone  to  school  with  had,  we 
think,  killed  her  first  husband  in  a  violent  encounter.   Grajina, 
the  girl,  had  married  a  Polish  army  officer  in  the  regular  Polish 
army,  who'd  been  in  a  saber  duel  and  had  the  end  of  his  nose  sliced 
off.  When  they  put  it  back  on  again,  they  put  it  on  a  little  bit 
crooked,  so  the  tip  of  his  nose  was  turned  about  thirty  degrees, 
[laughter] 

Anyway,  it  was  a  very  interesting  time  going  there.  Andrew 
was  a  very  handsome,  intelligent  young  man,  the  brother  of  Grajina. 
He  came  in  late  one  night,  and  we  asked  him  where  he'd  been,  and 
he  said,  "We  just  had  a  little  pogrom." 

Now  to  come  back  to  Casabla'nca:   I'd  operated  upon  a  German  and 
reconstructed  his  nerves  and  arteries,  and  I  was  rather  curious  to 
know  how  he  was  getting  along.   So  I  got  permission  to  get  a  jeep 
and  go  to  the  prisoner-of-war  camp  near  the  hospital.   I  saw  the 
patient,  and  his  wounds  had  healed,  and  he  was  coming  along  pretty 
well.   As  I  walked  out  of  the  prisoner-of-war  camp,  a  Polish  officer 
came  up  to  me,  and  he  said,  "Are  you  going  to  Casablanca?"  I 
said  yes,  and  he  said,  "Could  I  get  a  ride  with  you?"  I  said, 
"Sure,  get  in."  So  he  got  in,  a  nice  looking  fellow,  and  I  said, 
"Where  are  you  from  in  Poland?"  He  said,  "I'm  from  Druskininka." 
I  said,  "I  know  where  Druskininka  is.   It's  near  Wilno."  I  said, 
"Did  you  ever  know  a  Peatroscka  family?"  He  said,  "I'm  a  Peatroscka. 
My  name  is  Andrew."  Here  was  Andrew,  the  brother  from  Poland.   I 
had  met  him  casually  outside  of  a  prisoner-of-war  camp  in  North 
Africa! 

Then  subsequently  I  learned  the  story  of  what  had  happened  to 
Andrew.   He  had  joined  the  Allied  forces  in  Europe  and  was  chased 
out  of  Europe  with  the  English  and  went  to  England. 
There,  because  of  his  language  ability  and  intelligence,  he  was 
trained  as  a  paratrooper,  and  also  trained  in  observation  and 
other  things.   So  one  night,  when  he  was  fully  trained,  he  was  put 
ashore  from  a  submarine  near  Algeria.   He  was  supposed  to  disappear 


41 


Gerbode:   into  the  countryside  and  then  through  a  network  of  intelligence 

people  send  messages  back  as  to  the  number  of  planes  going  in  and 
out  of  a  certain  airport  and  various  items  of  that  type,  which  he 
successfully  did,  and  he  was  never  captured  by  the  Germans. 
Finally,  when  the  Allies  landed  in  North  Africa,  he  said,  "I  was 
a  member  of  the  welcoming  committee."  His  job  when  I  met  him  in 
North  Africa  was  to  interrogate  Polish  prisoners  who  might  defect 
when  they  got  well  and  join  the  American  forces.   That  was  what 
he  was  doing  actually  at  that  prisoner-of-war  camp. 

I've  subsequently  met  Andrew  several  times.   He'd  gotten 
rather  fat.   He  was  trained  as  an  engineer.   The  last  I  heard  of  him, 
he  was  in  South  America  somewhere.   The  mother  who  was  there  at 
that  time,  lost  her  second  husband.   She  came  to  the  United  States 
and  married  a  Kellogg,  the  very  rich  man  who  owns  much  of  the 
cereal  business.   She  then  moved  to  Minneapolis  or  St.  Paul  and 
lived  in  rather  splendid  circumstances  there,  but  never  would  help 
her  children.   I  think  Grajina  now  is  working  in  a  restaurant  in 
London. 


Palermo,  Sicily 


Gerbode : 


Hughes: 
Gerbode: 


In  any  event,  we  stayed  in  Casablanca  until  the  Germans  were  chased 
out  of  North  Africa,  which  took  about  seven  or  eight  months. 
Rather  heavy  fighting.   Then  we  went  to  Bezerte,  which  is  in  the 
north,  and  staged  in  an  olive  grove,  got  all  our  stuff  together, 
and  then  finally  we  were  put  on  a  boat  in  a  convoy  and  went  to 
Palermo,  Sicily,  the  Germans  having  just  been  driven  out  of 
there. 

There  was  a  bit  of  bombing  after  we  got  there,  but  not  very 
much.   Our  billet  as  a  hospital  was  in  the  University  of  Palermo 
Medical  School  building.   The  place  where  I  slept  was  the  professor 
of  orthopedic  surgery's  office.   That  was  quite  luxurious  compared 
to  the  other  things  we'd  done.   We  took  care  of  a  lot  of  Italian 
wounded  there  and  a  lot  of  Italian  prisoners  of  war,  who  defected 
by  the  hundreds.  They  were  pretty  tired  of  the  war  even  then  and 
were  easy  to  capture. 

Were  patients  coming  in  in  rushes? 

We  had  to  chase  the  Germans  off  of  Sicily,  so  there  was  a  lot  of 
fighting  right  up  to  the  Straits  of  Messina.   They  were  treated  in 
a  field  hospital  first  and  then  sent  to  us.   Sometimes  they  came 
to  us  straight  from  the  front,  but  usually  through  a  field  hospital. 


42 


Hughes:   Would  a  field  hospital  do  any  operating? 

Gerbode:  Yes.   They  were  doing  life-saving  procedures.   If  the  patients 

weren't  terribly  bad  off,  they  were  shipped  right  back  to  us,  and 
we  would  operate  upon  them  and  take  care  of  them.  There  was  a  lot 
of  illness.   There  were  a  lot  of  soldiers  with  hepatitis  and 
gastroenteritis  and  infectious  diseases  of  one  kind  or  other.   So 
we  had  a  lot  of  sick  soldiers. 

Hughes:   Typhus  was  a  problem  during  the  war,  wasn't  it? 

Gerbode:  A  bit,  yes.  There  were  a  certain  number  of  cases  of  typhus.  There 
were  a  certain  number  of  cases  of  tetanus,  particularly  among  the 
Germans,  and  some  of  the  Italians,  because  they  had  not  given  all 
their  soldiers  tetanus  antitoxin  or  tetanus  injections. 

Hughes:   Was  that  because  they  didn't  have  enough  to  go  around? 

Gerbode:   I  don't  think  they  had  enough  to  go  around,  and  they  perhaps  weren't 
so  concerned  about  it.   But  there  were  a  few  cases. 

In  any  event,  Patton  was  there,  too.  His  billet  was  in 
Palermo.  He  had  a  castle  there  when  he  was  sick  a  good  deal  of 
the  time  with  a  kind  of  bronchitis  and  other  things,  so  he  didn't 
really  get  up  to  the  front  at  all.   Our  [medical]  people  would  go 
see  him  and  take  care  of  him.   But  when  it  was  quite  apparent 
that  the  Germans  were  going  to  be  driven  out  of  Sicily,  he  put  on 
his  big  helmet  and  got  his  guns  and  went  up  in  his  jeep,  as  soon  as 
the  photographers  were  there.  He  made  a  triumphant  entry  so  that 
the  news  media  would  have  pictures  of  it  back  home.   I  don't  mean 
to  say  that  we  didn't  admire  him.   I  really  think  that  Patton  was 
one  of  our  greatest  generals.  He  was  a  terrible  person  when  he 
was  nonactive. 

Hughes:   Was  he  bad-tempered? 

Gerbode:  Well...  What  he  did  later  on  in  Europe  was  very  remarkable.   If  he 
had  had  his  way  and  hadn't  been  stopped  by  some  of  the  other 
generals,  I  think  the  final  solution  of  the  war  would  have  been 
completely  different. 

Hughes:   What? 

Gerbode:  He  would  have  taken  all  of  Czechoslovakia  and  Yugoslavia,  I'm  quite 
sure.   But  he  was  stopped  several  times. 


43 


Gerbode:   Anyway,  we  stayed  in  Palermo  for  quite  a  while.   We  must  have 

been  there  about  five  or  six  months.   Then  we  had  to  somehow  get 
a  landing  in  Italy,  so  they  landed  us  just  south  of  Salerno. 
General  Mark  Clark  was  in  charge  of  the  operation  there.  They 
just  barely  made  it,  as  a  matter  of  fact.   But  they  finally  did 
get  a  foothold,  and  also  at  Anzio.   At  Anzio  they  were  surrounded 
by  the  Germans  and  took  an  awful  beating. 

Hughes:   How  were  you  getting  news  about  all  this? 


Anzio 


Gerbode:   Through  the  wounded  soldiers  who  came  back.   Anyway,  we  stayed  in 
Palermo  until  it  looked  as  though  we  were  going  to  chase  the 
Germans  north.   Then  they  brought  us  over  just  south  of  Anzio.   Then 
we  went  into  Anzio  and  relieved  all  the  other  hospitals,  took  all 
their  wounded  and  let  them  go  on  up  toward  Rome.   Anzio  was  an 
absolute  stinkpot.   There  were  so  many  thousands  of  soldiers  in  a 
very  small  area,  that  about  every  hundred  feet  was  an  old  latrine. 
We  had  to  sleep  in  a  dugout  below  ground,  which  smelled  terribly, 
because  the  latrine  odors  seeped  through  all  the  soil.   It  wasn't 
very  pleasant. 

Hughes:   When  you  were  moving  like  this,  were  other  Americans  being 
relieved? 

Gerbode:  Yes. 

Hughes:   What  was  the  rationale  for  that? 

Gerbode:   There  were  different  kinds  of  hospitals.   There  were  field 

hospitals,  which  were  smaller  units.   They  were  up  closer  to  the 
front  than  we  were  usually.   We  were  a  big  unit.   We  had  a  capacity 
of  seven  hundred  and  fifty  beds  if  we  used  all  of  them. 

Hughes:    So  each  time  you  made  one  of  these  moves,  you  were  taking  all  the 
contents  of  your  hospital  along  with  you? 

Gerbode:   Yes,  everything.   Which  meant  truckloads  full  of  boxes  and  stuff. 
Hughes:   How  good  was  your  equipment  proving  to  be? 


44 


Gerbode:   It  was  fine.   The  replacements  were  excellent.   They  finally  sent 

us  good  generators  so  we  could  be  self-sufficient  with  electricity, 
and  the  kitchen  equipment  got  better  all  the  time. 

Hughes:   What  about  the  medical  equipment  itself? 

Gerbode:  The  medical  equipment  was  all  right.  We  had  to  improvise  our 

operating  rooms,  though.  What  we  did  was  make  floors,  so  we  could 
put  mobile  floors  in  sections  and  put  them  on  a  truck.  Then  when 
we  came  to  a  new  place,  we  could  just  lay  down  these  floors  and 
put  a  tent  over  the  top  of  them.   That  gave  us  a  pretty  good 
operating  room  complex. 

Hughes:   You  could  maintain  the  usual  sterile  conditions? 

Gerbode:   Yes,  it  was  surprising.  We  had  the  same  rules  in  the  operating 
room  as  we  had  at  home.   It  was  harder  to  maintain  them,  though, 
because  you  couldn't  keep  all  the  flies  out,  and  there  was  a 
certain  amount  of  dust  around.  But  it's  surprising  how  much  you 
could  do,  if  you  observed  certain  strict  rules  about  the  operations 
itself. 

Hughes:   Early  in  the  war  there  were  no  antibiotics,  were  there? 

Gerbode:  No,  there  weren't.  We  had  sulfanilamide.   Early  in  the  war,  it  was 
•thought  that  if  you  put  sulfanilamide  in  the  wounds,  this  would 
prevent  infection. 

Hughes:   You  mean  in  powder  form? 

Gerbode:   In  powder  form.   But  actually  that  proved  not  to  be  very  good. 

Hughes:   It  wasn't  effective? 

Gerbode:   It  wasn't  effective,  and  I  think  it  actually  in  some  cases  retarded 
healing,  too. 

Hughes:   And  that  was  only  effective  against  certain  bacteria  anyway, 
wasn't  it? 

Gerbode:  That's  right.   It  wasn't  until  later  that  we  got  penicillin.  That 
changed  things. 

Hughes:   This  was  just  a  year  or  so  before  the  war  was  over,  wasn't  it? 
Gerbode:   Yes. 


45 


Hughes:   That  must  have  made  a  tremendous  difference. 

Gerbode:   It  made  a  big  difference,  yes. 
## 


Wound  Treatment 


Gerbode:   A  lot  depended  on  how  you  treated  the  wounds.   You  see,  all  the 
wounds  were  left  open,  except  the  abdominal,  chest  and  brain 
wounds.   The  rest  of  them,  the  flesh  wounds,  were  all  left  wide 
open.   The  big  thing  was  to  let  them  granulate  for  a  while,  and 
then  do  secondary  closure.   That  was  something  that  really  was 
developed  on  a  big  scale  in  that  war. 

Hughes:   That  wasn't  a  prewar  technique? 

Gerbode:   Not  so  much.   So  when  we  did  the  original  debridement  of  a  wound, 
we  tried  to  debride  it  in  such  a  way  that  ten  days  later  or  two 
weeks  later,  it  could  be  closed  loosely.   We'd  try  to  think  of 
which  way  we'd  make  the  excision  so  it  would  be  easy  to  close  later. 

Hughes:   This  was  so  that  the  wound  would  drain? 

Gerbode:   Yes.   It  would  have  to  stay  open  until  it  was  not  grossly  infected. 
Of  course,  it  was  still  somewhat  infected,  but  as  soon  as  there  was 
healthy  granulation  tissue,  not  very  much  in  the  way  of  secretions, 
then  you  could  close  it  loosely.  That  saved  a  lot  of  time.  There 
were  a  great  many  things  about  the  war  which  we  learned  which  were 
new.   That  was  one  of  them,  secondary  wound  closure. 

Hughes:   Did  you  carry  on  that  technique  after  the  war? 

Gerbode:   It  was  used  later  in  the  war  and  in  accidental  injuries. 

In  any  event,  we  stayed  in  Anzio,  which  was  a  smelly,  rotten 
experience,  and  cleaned  up  the  patients  who  were  there,  shipped 
them  back  to  base  hospitals  or  put  them  back  into  active  duty. 
Meanwhile,  they  were  pushing  the  Germans  back  toward  Rome.   You 
may  remember  Cassino,  the  big  battle  there  where  some  of  the 
Germans  were  in  this  monastary  on  top  of  a  hill,  and  it  was 
devilishly  hard  to  get  them  off  those  buildings.   They  just  were 
terribly  resistant,  and  it  was  terribly  hard  to  get  at  them.   This 


46 


Gerbode:   is  where  the  Hawaiian-Japanese  division  did  such  a  noble  job. 

These  were  native  Japanese-Hawaiian  from  Hawaii  who  had  formed 
a  unit.  They  were  very  brave  and  did  a  tremendous  job  at  that 
point  in  the  war. 

Finally  the  Germans  were  driven  up  north.  They  were  pretty 
upset  with  the  number  of  Italians  who  were  defecting  or  giving  up. 
They  got  pretty  stern  and  strict  with  them.  We  don't  know  all  the 
things  they  did  to  try  to  keep  the  Italians  fighting,  but  they 
tried  everything.   They  were  finally  driven  back  over  the  Brenner 
Pass  into  Austria. 


Salerno  and  Southern  France 


Gerbode:  We  stayed  there  for  quite  a  while,  and  then  we  went  back  to  Salerno, 
which  is  where  the  original  landings  were.  Here  we  took  care  of 
the  troops  while  they  were  training  for  the  landing  in  southern 
France.   That  was  mainly  station  hospital  kind  of  work,  taking 
care  of  whatever  injuries  they  had  or  other  things. 

Hughes:   You  mean  not  combat. 

Gerbode:  Not  combat.   They  were  staging  for  the  landing  in  southern  France. 
The  other  big  units  were  staging  in  England,  too,  for  the  landing 
in  Normandy  at  the  same  time. 

Finally,  everybody  was  ready.  The  artillery  was  ready.   The 
infantry  was  ready.   So  we  all  got  in  a  gigantic  convoy  in  Salerno 
and  started  going  toward  southern  France.  When  we  got  to  southern 
France,  we  didn't  know  how  many  Germans  were  still  left,  so  they 
just  blasted  Saint -Tropez,  that  beautiful  place.   Every  house  that 
was  in  view  that  looked  as  though  it  might  have  a  machine  gun  in 
it  had  a  shell  go  through  it.   But  we  landed  without  much  resistence. 
The  Germans,  meanwhile,  had  gotten  pretty  weak  and  had  started 
evacuating  up  toward  the  north. 

Then  after  getting  there,  we  set  up  a  series  of  hospitals,  and 
I  was  then  appointed  the  job  of  selecting  the  place  where  the 
hospital  should  be  and  getting  it  started,  again  this  darn  logistic 
job. 

Hughes:    [laughs]  You  had  a  reputation. 


47 


Gerbode:   One  of  my  problems  in  the  army  was  to  keep  that  logistic  number 

off  my  records,  because  I  felt  that  if  I  had  a  logistic  number,  I'd 
be  taken  out  of  the  hospital  and  put  back  in  headquarters  somewhere 
in  a  planning  unit.   I  didn't  want  to  do  that.   So  I  got  to  know 
the  chief  sergeant  in  the  office  who  controlled  these  numbers — 
they  were  called  MOS  numbers — and  bribed  him  to  keep  that  MOS 
number  off  my  file.   Which  he  did.   [laughs] 

Then  we  started  chasing  the  Germans  up  the  Rhone  Valley. 
We'd  no  sooner  get  a  hospital  set  up  than  they'd  say,  "You've  got 
to  move  it  now.   Tomorrow  we  move  up  another  fifty  miles  or  so." 
We  set  up  three  hospitals  before  we  got  to  a  little  town  called 
Carpentras.   Now  the  story  goes  back  to  before  the  war  again. 


The  Story  of  Carpentras* 


Gerbode:   My  wife  and  I  got  to  know  Lily  Pons  and  Andre  Kostelanetz  quite 

well.   They  came  to  the  Hawaiian  Islands  and  had  part  of  a  summer 
with  us.   Then  periodically  when  they  came  to  California,  they 
would  stay  with  us  or  we  would  see  them. 

They  had  a  friend  by  the  name  of  Bill  Schweitzer  in  Elizabeth, 
New  Jersey,  who  is  a  short-wave  expert  and  was  president  of  a 
large  paper  company  which  made  paper  for  Chesterfield  cigarettes. 
The  linen  for  their  paper  largely  came  from  southern  France.   I 
didn't  realize  that  linen  was  such  an  important  part  of  making 
cigarette  paper,  but  apparently  it  is. 

In  any  event,  as  things  got  closer  to  our  being  involved  in 
the  war,  I  would  see  Andre  and  Lily  once  in  a  while  in  New  York, 
and  also  got  to  know  Bill  Schweitzer  pretty  well,  and  actually 
visited  him  in  New  Jersey.   Then  when  we  got  into  the  war  and  I  got 
a  commission,  it  was  apparent  that  I  was  going  to  be  sent  with  our 
unit  to  the  European  theater  one  way  or  the  other,  and  Bill 
Schweitzer  also  had  joined  the  army.   He  once  said  to  me  in  New  York, 
"If  you  ever  get  to  southern  France,  we  haven't  heard  anything 
from  our  factory,  which  was  taken  over  by  the  Germans,  please 
look  up  our  manager,  we  don't  know  what  happened  to  him.   His  name 
is  Mr.  LaDerriere.   Tell  him  that  our  family  is  fine  and  that  you'd 
like  to  have  him  get  in  touch  with  us." 


*The  section  on  Carpentras  was  moved  from  the  interview  on  10/23/83. 


48 


Gerbode:   So  the  war  went  on,  and  we  went  through  Africa  and  Sicily  and  Italy 
and  finally  landed  in  Saint-Tropez  with  an  invading  army  and 
worked  our  way  up  through  southern  France  through  the  Rhone  Valley, 
making  two  or  three  stops,  chasing  the  Germans  up  there,  and  finally 
landed  in  a  small  village.   After  setting  up  the  hospital  several 
times  for  a  period  of  a  few  days  or  a  week  and  then  tearing  it 
down  and  moving  on,  finally  I  picked  a  field  near  a  village  in 
southern  France.  After  getting  things  organized  and  deciding  where 
the  tents  would  go  up  and  so  forth,  I  was  sitting  on  my  cot,  I 
pulled  out  my  wallet ,  and  saw  a  note  to  look  up  somebody  in 
Carpentras.   So  I  asked  somebody  near  me  if  he  knew  where  Carpentras 
was,  and  he  pointed  to  a  village  in  full  view  a  few  miles  away 
and  said,  "That's  Carpentras  right  over  there." 

So  I  got  on  my  bicycle,  which  I  had  secretly  stored  with  the 
surgical  equipment ,  and  went  over  to  the  village  and  asked  somebody 
if  they  knew  where  Mr.  LaDerriere  lived,  and  he  said,  "Yes,  that's 
his  house  over  there."  So  I  went  over  and  range  the  doorbell  and 
Mr.  LaDerriere  opened  the  door,  very  surprised  to  find  somebody 
from  America.  Actually  our  hospital  had  liberated  that  town,  in  a 
sense.  Non-fighting  liberation,  but  we  were  the  first  American 
troops  to  stop  near  there  and  do  anything  about  the  little  village. 
So  he  was  overwhelmed  with  joy  to  find  the  Germans  had  been  chased 
away  and  to  find  somebody  who  knew  his  boss. 

He  had  a  rabbit  which  he  cooked.  We  had  some  wine  and  talked 
a  good  deal.   He  spoke  very  good  English.   Then  we  ceremoniously 
took  Hitler's  picture  off  the  wall  and  put  up  his  father's  picture, 
which  he  had  secretly  stored  in  the  attic.  A  fine  bearded  Jewish 
gentleman.   Big  tears  flowed  during  this  emotional  ceremony. 

I  also  took  a  trip  later  on  over  to  the  factory  where  they 
made  paper.   But  the  main  thing  was  that  he  introduced  me  to  the 
mayor  and  photographer  of  the  town,  both  very  good  friends  of  his. 
We  had  a  meal  or  two  there  as  well.  Actually,  our  unit  didn't 
stay  there  longer  than  a  week  or  two,  because  we  were  chasing  the 
Germans  pretty  hard  at  that  point,  and  finally  ended  up  quite  a 
bit  further  north.   But  anyway,  we  said  fond  farewells,  and  I  said 
I'd  be  back  one  day  to  see  him. 

So  after  the  war  I  was  teaching  in  London  and  had  a  vacation 
period  and  decided  to  visit  some  friends  near  Ez-Sur-Mer  on  the 
Mediterranean.   My  wife  meanwhile  had  gone  down  there  to  stay  with 
them.   I  had  my  oldest  son  with  me  in  London,  the  one  who  was 
killed  at  Stanford.  We  decided  to  drive  through  southern  France 
and  go  to  Ez  to  meet  my  wife  and  daughter.  We  stopped  in  Carpentras 


49 


Gerbode:   on  the  way  down,  having  told  them  that  I  was  going  to  be  there  on 
a  certain  day  around  late  afternoon.   Well,  we  got  there  and  they 
laid  on  the  most  terrific  banquet  you've  ever  seen  in  your  life. 
The  mayor,  the  photographer,  Mr.  LaDerriere,   and  a  couple  of  other 
friends  of  his  took  over  a  whole  restaurant.   We  started  eating 
about  four  o'clock  in  the  afternoon  and  had  about  ten  courses. 
Each  one  we  thought  was  going  to  be  the  last,  and  it  wasn't.   With 
all  kinds  of  wine  and  everything.   We  finally  got  out  of  there  at 
nine  o'clock.   And  I  still  had  to  drive  all  the  way  down  to  Ez. 
But  anyway,  it  was  a  great  occasion  with  speeches  and  all  this  sort 
of  stuff.   We  set  out  for  Ez  about  nine  o'clock.   About  a  mile  out 
of  town  I  stopped  and  Alec  got  rid  of  the  entire  dinner.   Then  he 
felt  much  better. 

We  finally  arrived  at  Ez  about  one  o'clock  in  the  morning,  and 
my  wife  and  the  hostess  were  still  waiting  outside  on  the  terrace 
for  us  to  arrive.   We  had  a  little  confusion  in  finding  the  place 
that  delayed  us  about  half  an  hour,  but  we  got  there  safely.   So 
that  is  the  story  of  Carpentras. 

Hughes:  How  is  your  French? 

Gerbode:  No  good. 

Hughes:  Was  this   going  on  in  French? 

Gerbode:  They  were  all  talking  in  broken  but  understandable  English. 

So  we  stayed  in  Carpentras  for  about  two  weeks  and  gradually 
went  up  north  in  several  hops  until  we  got  to  Epinal  and  set  up  a 
hospital  in  an  old  French  barracks. 


Field,  Mobile  and  Base  Hospitals 


Hughes:   When  you  were  moving  so  often,  what  happened  to  soldiers  that  were 
wounded  and  needed  care? 

Gerbode:   We  would  take  care  of  any  freshly  wounded  patients,  and  then  the 
ambulances  would  take  them  to  an  evacuation  port  where  they  were 
put  on  a  ship  and  sent  home,  or  sometimes  flown  home  in  ambulance 
planes  to  base  hospitals  in  the  United  States  or  England. 

Hughes:   But  at  some  point  it  seems  that  you  would  be  in  transit  when 
patients  were  needing  care. 


50 


Gerbode:  There  were  field  hospitals  right  close  up  to  the  mobile  [hospital]. 
Then  as  we  penetrated  further,  the  army  set  up  our  own  general 
hospitals.   We  had  a  big  general  hospital  in  Italy  and  later  a 
big  general  hospital — they  call  them  a  base  hospital — in  France 
as  well.  We  would  send  [the  wounded]  back  to  these  base  hospitals 
where,  if  they  were  recoverable  and  could  be  put  back  into  combat 
duty  within  a  reasonable  time,  they  stayed  until  they  were  ready 
to  go  back. 

Hughes:   So  there  were  about  four  different  types  of  hospitals? 

Gerbode:  We  had  special  hospitals.  We  [also]  had  [special]  groups.   Actually, 
these  were  teams  which  went  into  field  hospitals  and  operated  as  a 
team.  We  had  a  chest  unit,  for  example,  which  some  of  my  friends 
were  associated  with.  We  had  neurological  outfits.   They  would 
go  into  a  place  where  there  was  heavy  fighting  and  take  care  of 
these  specialty  cases. 

Hughes:   How  broad  an  area  would  a  team  like  that  cover? 

Gerbode:  They  would  set  up  close  to  a  combat  area.  They  called  them  auxiliary 
teams.  We  had  maybe  three  or  four  of  them  in  North  Africa  and  the 
same  ones  then  went  into  southern  France  later.   They  were  mainly 
operating  teams,  teams  that  were  operating  on  special  cases.   They 
didn't  take  care  of  all  these  special  cases,  though,  because  some 
of  them  came  to  us  anyway. 


The  German  Retreat  to  the  Vosges  Mountains 


Gerbode:  Meanwhile  the  Normandy  landing  had  taken  place,  and  that  really 
made  the  Germans  think  twice  about  what  was  going  to  happen,  but 
they  hadn't  given  up  at  all.  We  chased  the  Germans  back,  and  they 
got  to  the  Vosges  Mountains,  where  they  consolidated  everything. 

On  the  way  up  to  the  Vosges  Mountains,  the  Germans  who'd  been 
in  the  southern  part,  from  Saint -Tropez  up  to  the  Vosges  Mountains, 
had  lost  a  lot  of  their  equipment  and  trucks,  and  the  whole  roadside 
all  the  way  up  was  littered  with  wagons  and  dead  horses  and  wounded, 
and  everything  else,  because  actually  they  were  just  sitting  ducks 
for  the  air  force.  All  it  had  to  do  was  go  up  and  down  and  strafe 
them.  Their  casualty  loss  was  terrific.  They  lost  most  of  their 
equipment  which  they'd  had  down  there,  which  wasn't  very  much,  I 
guess.   But  they  got  enough  of  it  together  to  set  up  a  pretty  strong 
line  in  the  Vosges  Mountains. 


51 


Gerbode:   Then  we  were  stuck  there  trying  to  get  them  out  of  these  mountains 
for  quite  a  while.   We  had  very  heavy  casualties  there.   We  were 
extremely  active.   But  luckily,  we  had  this  old  French  barracks  in 
Epinal  set  up  as  a  hospital.  When  I  went  there  to  set  this  place 
up,  the  German  operating  list  was  still  there  in  German  script  on 
a  chalkboard.   There  was  potato  salad  all  over  the  place. 
Mattresses  were  bloody  and  dirty.   I  had  them  take  everything  out 
of  the  place,  put  it  in  the  yard,  pour  gasoline  on  it,  and  burn  it 
all  up .   Then  we  moved  in  our  own  equipment . 

• 

Hughes:   Did  it  make  any  difference  in  any  way  whether  you  were  dealing 
with  an  American  or  a  German  wounded? 

Gerbode:   No,  we  treated  them  all  exactly  the  same.   Actually,  there  were 

always  other  nationalities  around  who  were  watching  out  for  their 
people.  For  example,  there  was  always  a  Polish  liaison  officer 
who  would  watch  out  for  Polish  prisoners  or  wounded  and  try  to  see 
how  they  felt  about  the  war  and  see  whether  or  nor  they  were  good 
enough  to  fight  for  the  Americans  when  they  got  well. 

Oh,  incidentally,  at  that  time  this  Mr.  Schweitzer  whom  I 
mentioned  before  had  gotten  into  the  army  and  was  in  charge  of 
rehabilitating  prisoners  of  war  or  moving  them  out  to  one  place  or 
another.   He  found  out  where  I  was,  and  he  came  to  the  hospital, 
and  he  didn't  recognize  me,  I  was  so  thin.   [laughter]   I  didn't 
realize  how  thin  I'd  gotten. 


Wartime  Surgery 


Hughes:   What  sort  of  hours  were  you  working? 

Gerbode:   Sometimes  we'd  work  almost  twenty-four  hours,  if  it  was  very  busy. 
Then  we'd  just  flop  down  and  get  some  rest  and  start  over  again. 
At  other  times,  we  wouldn't  have  anything  to  do  for  days  and  days. 

Hughes:   Were  you  learning  a  lot? 

Gerbode:   Harvey  Gushing  said,  "War  surgery  either  makes  or  breaks  a 

surgeon."   If  he  goes  into  the  war  not  knowing  much  surgery  and  does 
a  lot  of  war  surgery,  he  compounds  his  mistakes  and  comes  out  really 
worse  off.   But  if  he's  well-trained  and  applies  his  good  training 
to  war  surgery,  then  he'll  come  out  knowing  more  than  he  did  when 
he  went  in.   I  think  that's  true.   In  our  unit,  which  was  mainly  an 


52 


Gerbode:  academic  unit,  we  kept  applying  our  training.   I  think  it  was 

quite  apparent,  and  word  would  get  back  from  base  hospitals,  that 
they  liked  the  way  we  treated  the  wounds.   They  had  to  cope  with 
fixing  them  up  afterwards. 

Hughes:   Were  you  having  to  operate  much  more  quickly  than  you  were  used  to 
at  home? 

Gerbode:  Oh,  sometimes  you'd  stay  there  for  twelve  hours  and  do  twelve, 

fourteen,  fifteen,  or  twenty  cases.   It  was  a  real  assembly  line. 

Hughes:   I  was  wondering  about  blood  substitutes.  Wasn't  that  a  problem 
earlier? 

Gerbode:   Yes.   Blood  and  plasma  were  sent  to  us  overseas.   We  never  really 
had  quite  enough  of  them. 

Hughes:   How  were  they  sent? 

Gerbode:   They  were  sent  over  cold  in  airplanes  from  the  United  States,  mainly. 
Sodium  pentathol  was  a  very  useful  drug.   We'd  have  one  man  just 
fixing  up  syringes  of  sodium  pentathol.   That's  all  he  did. 

Hughes:  You  could  keep  supplies  like  that? 

Gerbode:  They  kept  us  well  supplied  with  things  like  that. 

Hughes:  When  you  ran  out  of  blood,  then  you  were  forced  to  use  plasma? 

Gerbode:  Then  we  used  plasma  or  glucose. 


Heidelberg 


Gerbode:   Finally  they  chased  the  Germans  out  of  the  Vosges.   I  was  lucky  to 
get  out  soon.   I  went  right  to  Heidelberg,  which  is  a  place  I  had 
known  before  the  war,  and  went  to  the  university  hospital.   It 
was  very  interesting,  because  the  Germans  had  left  their  wounded  in 
the  hospital.   They  were  using  paper  casts  for  fractures.   They  had 
run  out  of  plaster.   You  could  see  that  their  treatment  was  beginning 
to  get  pretty  second  or  third  rate  at  that  point.   The  professor 
of  surgery  met  Tie,  a  fellow  by  the  name  of  Wolf,  as  I  recall. 
He  showed  me  around  the  hospital  and  introduced  me  to  some  of  the 
other  academic  people  there.   I  guess  we  had  blown  up  the  bridge 


Two  sides  of  a  postcard 
sent  from  Europe  by 
Lt.  Col.  Frank  Gerbode 
shortly  before  his  return 
home. 


53 


Gerbode:   across  the  river,  so  they'd  run  out  of  water,  because  the  water 
came  across  on  the  bridge.   That  was  a  problem  until  the  army 
built  another  bridge  and  brought  the  water  back  again. 

Hughes:   When  you  went  into  a  hospital  like  that,  would  you  just  literally 
take  over? 

Gerbode:   Oh,  yes. 

Hughes:   What  would  happen  to  people  like  Wolf? 

Gerbode:   He  stayed  on.   In  fact,  he  even  stayed  on  as  professor  after  the 

war,  until  Fritz  Linder  went  there  to  take  his  place.   In  fact  he 
stayed  on  after  that.   They  gave  him  a  cancer  institute  to  run. 

Hughes:   But  he  wouldn't  have  been  caring  for  patients  once  the  Americans 
arrived? 

Gerbode:   No.   I  think  they  let  him  take  care  of  the  Germans  who  were  still 
there,  but  not  the  Americans.   We  moved  in  our  whole  unit  there. 


Mutzig 


Gerbode:   We  moved  out  of  that  area  and  chased  the  Germans  all  the  way  up  to 
the  Rhine.   I  set  up  a  beautiful  little  hospital  in  Mutzig  which 
is  in  view  of  Strasbourg  across  the  Rhine.   I  set  it  up  in  the 
middle  of  the  night  in  a  gigantic  rainstorm.   It  was  in  an  old 
French  barracks.   Our  boys  really  did  a  tremendous  job  of  converting 
it  into  a  hospital.   They  worked  just  like  demons.   It  became  a 
beautiful  little  hospital  in  about  forty-eight  hours. 

We  took  care  of  the  wounded  there  for  about  two  weeks.   This 
was  over  Christmas.   We  had  a  Christmas  tree.   The  Germans  were  on 
the  other  side  of  the  Rhine  at  that  time,  which  was  not  too  far 
away.   Every  once  in  a  while,  they'd  come  over  and  bomb  some  of  the 
units  nearby.  They  tried  to  knock  out  the  water  tower,  for  example, 
that  we  were  using,  but  they  missed  it. 


54 


The  Battle  of  the  Bulge 


Gerbode:  Then  around  New  Year's  Eve,  the  Battle  of  the  Bulge  started.   We 

had  to  pack  up  and  get  out  within  twelve  hours.   They  sent  ambulances 
up.   They  took  all  the  patients  back  to  base  hospitals  or  other 
hospitals.  We  packed  everything  up  and  rushed  out  of  there  on  the 
way  back  to  the  other  hospital  in  Epinal,  which  we  had  left 
previously.   This  was  an  evacuation  of  about  a  hundred  miles.   In 
the  excitment  our  executive  officer,  who  was  a  doctor,  was  in  a 
jeep  which  was  run  over  by  a  French  tank.   It  was  on  the  wrong  side 
of  the  road.  He  was  killed. 

Anyway,  we  went  all  the  way  back  to  our  previous  base  and 
stayed  there  until  the  Battle  of  the  Bulge  stabilized.   It  was  kind 
of  a  scary  business  for  a  little  while.   But  we  got  out  in  time. 


Wartime  Surgery  (Continued)// # 
[Interview  3:  August  8,  1983] 


Hughes:   Dr.  Gerbode,  we  talked  some  about  the  war,  but  perhaps  you  could 
tell  me  a  little  bit  about  how  you  were  actually  set  up  for 
surgical  procedures. 

Gerbode:  We  first  of  all  had  to  get  a  hospital  put  together  in  a  number  of 
hours  to  take  care  of  the  injured  and  wounded.   So  the  idea  was 
to  set  up  the  hospital  in  units.  We  first  set  up  an  intensive 
care  unit,  which  is  where  the  patients  would  be  triaged.  The  word 
triage  means  to  separate  the  patients  into  emergency  cases  and 
patients  who  can  wait,  those  who  were  medical  and  those  who  were 
surgical.   The  triage  team  in  the  receiving  tent  did  this  work. 
The  wounded  and  the  sick  would  come  in,  and  then  they  would  be 
separated  into  these  groups. 

The  second  thing  we  put  up  was  the  operating  room.  Then  a 
fifty-bed  ward.   This  would  all  go  up  within  five  or  six  hours. 
We  had  floors  for  the  operating  room  and  special  tents.   The 
packages  of  instruments  and  drugs  were  all  ready  to  go  as  soon  as 
we  got  the  boxes  unloaded  from  the  trucks. 

The  operating  teams  would  then  be  ready  to  start  operating. 
Usually  it  was  a  surgeon  and  an  assistant  surgeon,  and  sometimes 
a  noncommissioned  officer,  a  sergeant  or  somebody  like  that. 


55 


Hughes:   Were  those  teams  static?  Did  you  work  with  the  same  group? 

Gerbode:   Not  always,  but  pretty  much  they  worked  together.   I  had  the  same 

assistant  pretty  much  during  most  of  the  activity.   The  other  thing 
was,  to  use  the  noncommissioned  officers  and  sergeants.   It  was 
great  to  train  some  of  these  fellows  to  be  assistants.   After  a 
while,  they  were  so  good,  they  were  really  better  than  some  of  the 
doctors,  because  they  would  do  what  you  told  them  to  do,  and  they 
would  remember.   Then  they'd  do  it  exactly  the  same  the  next  time. 
There  was  never  any  argument  about  what  they  should  do  when  they 
were  assisting.   Not  that  the  doctors  would  argue,  but  still,  it 
was  great  having  a  first-class  assistant.   I  had  two  that  were 
excellent.   I  think  I  mentioned  their  names  before.   One  of  them 
was  Querhammer ,  who  was  a  farmer  from  the  Middle  West.   The  other 
was  Carson,  who  was  a  carpenter  from  Los  Angeles.   I've  lost  track 
of  Querhammer,  but  Carson  is  a  successful  contractor  now.   I  met 
him  a  couple  of  years  ago.   Very  attractive,  very  intelligent  guy. 

The  patients  would  be  brought  into  the  operating  room,  the 
ones  who  needed  operations,  and  we  had  one  captain  who  was  assigned 
to  arranging  all  the  anesthesia.   He  immediately  would  get  busy 
getting  the  anesthetic  things  together.  Sometimes  he  would  be  an 
anesthetist,  and  sometimes  other  doctors  would  act  as  anesthetists. 
Sometimes  we'd  use  the  nurses.   Then  we  would  operate,  and  then 
the  patients  would  go  back  to  a  recovery  room,  which  was  another 
tent,  where  they  would  sometimes  be  evacuated  in  a  day  or  two  or 
three  to  another  base  hospital  or  might  even  stay  there  if  we 
thought  they  would  recover  quickly.   The  patients  would  come  in 
pretty  muddy  and  pretty  messed  up,  so  it  was  a  job  getting  them 
cleaned  up  so  that  they  could  be  operated  upon.   But  luckily,  they 
were  mostly  in  good  health,  so  you  were  operating  upon  somebody  who 
was  young  and  healthy,  and  this  helped  a  good  deal,  particularly 
when  we  had  enough  blood  so  we  could  replace  their  blood  loss. 

We  tried  to  send  patients  to  tables  where  the  surgeons  had  a 
little  more  expertise  in  one  field  rather  than  another,  and  this 
meant  that  those  who  had  good  orthopedic  training  would  get  most 
of  the  bone  injuries,  and  those  who  had  other  training  would  get 
the  other  kind  of  [injuries].   My  table,  I  guess,  got  pretty  much 
anything  that  came  along.   We  had  lost  our  neurosurgeon  somewhere 
along  the  line,  so  that  we  had  to  do  the  neurosurgery  as  well  as 
the  general  and  thoracic  surgery.   I  had  to  do  a  fair  number  of 
brain  cases  and  spinal  cord  injuries  as  well. 

Hughes:   Had  you  done  anything  like  that  before? 


56 


Gerbode: 


Hughes : 
Gerbode: 

Hughes : 
Gerbode: 


Hughes : 

Gerbode: 

Hughes: 


I  was  trained  in  neurosurgery  to  a  certain  extent  during  my 
residency,  so  I  knew  the  essential  features  of  it.   There  were 
some  pretty  horrible  injuries.   For  example,  I  had  several 
patients  who  had  had  both  their  eyes  shot  through  with  frontal 
brain  bullet  wounds.   Pretty  much  of  a  mess  to  see  them.   One 
would  have  to  enucleate  the  remnants  of  the  eyes  and  patch  them 
up  so  they  wouldn't  get  meningitis.   It's  a  curious  thing  that  one 
of  these  fellows  had  part  of  the  frontal  lobe  shot  away  and  one  eye. 
I  had  gotten  some  preserved  dura  mater,  which  I  used  to  cover  over 
the  defects  on  the  brain  so  that  the  brain  wouldn't  become  infected 
or  exposed. 

A  curious  thing,  many  years  later  in  the  old  Stanford  Hospital, 
I  was  having  rounds,  and  there  was  a  fellow  on  the  eye  service,  and 
somebody  mentioned  my  name.   He  said,  "Is  that  Dr.  Gerbode  who  was 
in  the  war  in  France?"  I  said  yes.   He  said,  "You  operated  upon 
me  and  removed  an  eye  in  France  during  the  war."  He  said,  "I've 
never  forgotten  your  name."  He  came  in  for  some  plastic  surgery  on 
his  eye. 

That  use  of  dura  mater,  was  that  something  new? 

No,  I  guess  it  was  generally  used  by  some  people.   It  was  a  piece 
of  tissue  that  you  could  use  to  cover  the  brain.   It  was  available 
because  there  were  enough  dead  soldiers  to  give  us  the  material. 

There's  not  a  problem  with  rejection? 

No,  it  would  be  incorporated  in  the  scar  tissue. 

Anyway,  sometimes  we'd  operate  for  long  hours.   We'd  have  to 
operate,  obviously,  until  all  the  wounded  were  taken  care  of.   If 
you  got  overly  tired,  you  could  rest  for  a  couple  of  hours  and 
then  come  back.   Usually  it  was  a  matter  of  working  maybe  twelve- 
fourteen  hours  and  then  having  a  quick  ward  round  on  the  patients 
upon  whom  you'd  operated,  although  they  were  well  taken  care  of  by 
ward  surgeons  who  were  assigned  more  or  less  to  postoperative 
care.   Then  you'd  flop  down  in  your  bed  and  maybe  try  to  get  a 
shower  and  something  to  eat,  and  then  go  back  on  the  line  again. 

How  many  were  you? 

I  think  we  had  forty-nine  officers  and  fifty-two  nurses. 

And  all  the  officers  had  medical  training? 


57 


Gerbode:   No.   They  were  about  half  medical  and  half  surgical,  and  various 

levels  of  training.   I  was  lucky,  although  I  was  young  and  not  too 
far  out  of  my  surgical  residency,  I  was  given  a  major's  commission. 
This  was  pretty  good  for  a  young  guy  going  right  into  the  war. 

Hughes:   Why? 

Gerbode:   Because  I'd  had  very  good  training,  and  they  recognized  this.   Then 
there  was  an  opening  in  the  unit,  so  I  fitted  the  bill  pretty 
well  and  got  the  commission.   This  of  course  was  a  great  help, 
because  being  a  senior  officer  gave  me  lots  of  opportunities  which 
I  wouldn't  have  had  if  I  was  a  junior  officer. 

Hughes:   You  haven't  said  anything  about  diagnostic  tools. 

Gerbode:   We  had  a  mobile  xray  machine  which  we  used.   We  had  a  whole  team 

of  roentgenologists  who  did  nothing  but  take  pictures  and  interpret 
them.   They  were  pretty  fast  at  it,  so  that  if  you  had  a  compound 
wound  with  a  fracture,  they'd  have  a  picture  for  you  in  fifteen 
minutes  or  so.   Then  you  could  use  that  to  decide  what  to  do  about 
the  patient. 

We  were  lucky  in  having  surgeons  who  were  very  good  at 
orthopedic  surgery,  particularly  Dr.  Matthewson,  who  was  the  chief 
surgeon.   He  had  had  good  training  in  fractures  and  bone  injuries, 
both  in  Europe  and  at  San  Francisco  General  Hospital,  so  he  helped 
a  lot  to  establish  the  kind  of  operations  which  would  be  best  for 
these  patients. 

There  were  quite  a  few  joint  injuries  which  required  special 
care.   We'd  try  to  get  them  cleaned  up  and  closed  so  that  they 
wouldn't  be  infected.   An  infected  joint  is  pretty  difficult  to 
cope  with  later. 

The  operating  activity  would  come  in  great  bursts  of  furious 
work  and  then  there  would  be  periods  when  there  wouldn't  be  anything 
to  do  for  quite  a  while.   This  is  bad  in  any  army  or  navy  unit, 
because  then  everybody  starts  looking  around  and  finding  things  to 
complain  about.   Usually  it's  the  army  or  the  commanding  officer, 
and  anything  bad,  including  the  food.   I  tried  to  avoid  these  long 
discussions  as  much  as  possible,  and  maybe  that's  why  the  commanding 
officer  gave  me  these  special  assignments,  because  he  realized  I 
didn't  want  to  sit  around  and  gripe  very  much.   I  would  much  rather 
be  busy  doing  something  than  worrying  about  what  was  wrong  with  the 
army. 


58 


The  German  Wounded 


Gerbode:  We  had  interesting  cases  ,  because  as  the  war  progressed,  we  of 

course  had  many  German  wounded  and  also  some  other  ancillary  wounded, 
some  Poles  and  Hungarians  and  others ,  who  had  been  brought  into 
the  German  army.   But  they  were  mainly  Germans,  and  the  farther 
along  we  got  in  the  war,  they  were  younger  soldiers — they  were  just 
boys,  really — and  older  ones.   The  middle  ones  had  either  been 
shot  up  pretty  badly  or  been  captured  or  killed. 

Hughes:   How  young  were  the  youngest? 

Gerbode:   I  guess  they  were  fifteen,  sixteen,  and  seventeen.   Toward  the  end 
they  were  just  kids. 

Hughes:   And  probably  no  time  for  much  training. 

Gerbode:  They  weren't  very  well  trained.   The  older  ones  were  kind  of 

tired  of  the  war,  and  many  of  them  had  been  wounded  in  previous 
battles.  All  the  German  soldiers  in  France  had  a  peculiar  smell 
about  them.   They  didn't  seem  to  have  time  to  get  fresh  clothes  or 
take  baths,  so  they  all  smelled  pretty  badly. 

Hughes:   Did  they  come  in  with  diseases  as  well  as  injuries? 

Gerbode:  They  had  some  diseases.   One  thing  that  I  think  I  mentioned  before, 
they  weren't  very  well  protected  against  tetanus,  so  some  of  them 
got  tetanus  from  their  contaminated  wounds.  We  had  tetanus 
antitoxin;  we  could  give  it  to  them,  but  that  doesn't  cure  people 
right  away.   They  were  not  very  well  fed,  because  Germany  was 
running  out  of  food  for  them.   They  certainly  ate  a  lot  of  potatoes 
and  that  sort  of  thing. 

Hughes:   Because  they  weren't  in  as  good  health  as  the  American  boys,  did 
you  have  more  problems  postoperatively? 

Gerbode:  No,  they  were  in  good  enough  shape  so  they  came  through  pretty  well. 

Anyway,  it  was  a  very  sad  experience  to  have  built  this 
beautiful  little  hospital  in  Mutzig  near  Strasbourg  on  the  Rhine. 
We  could  look  out  and  see  the  Rhine  from  this  old  French  barracks, 
and  we  knew  the  Germans  were  on  the  other  side  of  it,  until  the 
Battle  of  the  Bulge.   It  really  was  a  very,  very  nice  little 
hospital,  and  we  were  terribly  busy  there.   I  had  it  organized  so 
that  we  were  really  almost  like  a  regular  hospital,  because  we  had 
walls  and  water. 


59 


Booby  Traps  and  Mines 


Hughes : 
Gerbode: 


Gerbode:   Another  thing  that  I  found  out,  when  we  started  exploring  places 
to  set  up  hospitals,  you  had  to  watch  out  for  booby  traps.   Those 
clever  Germans  would  put  a  little  bomb  on  a  toilet  flushing  chain, 
or  they  put  something  that  would  look  like  a  little  prize  or  a 
souvenir  on  a  pedestal.   If  you  picked  it  up,  the  thing  would  explode 
and  blow  your  hand  off.   So  we  were  very  careful  about  any  objects 
like  that. 

Did  you  have  a  crew  that  went  through  when  you  first  arrived? 

Yes.   Then  of  course  in  some  areas  they  had  mined  the  roads  and 
the  areas  around  where  they  thought  the  [U.S.]  army  might  go. 
So  the  army  had  a  whole  team  of  people  that  would  go  ahead  and  find 
out  about  mines  and  remove  them.   Some  of  the  mine  wounds  were 
terrible.   They  had  a  cement  mine  which,  when  it  exploded,  would 
drive  hunks  of  cement  into  the  tissues.   Of  course  that  makes 
terribly  infected  wounds.  We  had  a  terrible  time  getting  some  of  that 
[out]. 

Hughes:   Was  that  the  point? 

Gerbode:   That  was  the  point  of  it.   It  was  cheap  to  make  them  out  of  cement 
rather  than  steel  or  nails  or  whatever.  Then  wien  they  exploded 
and  drove  these  hunks  of  cement  into  the  tissues,  they  all  had  to 
be  gotten  out,  otherwise  they  were  surely  going  to  cause  infection. 
When  they  went  in  through  cloth,  they  carried  bits  of  cloth  with 
the  pieces  of  cement.   That  all  had  to  be  removed.   It  was  pretty 
messy. 


Pushing  Back  the  Germans 


Gerbode:   When  they  drove  us  all  the  way  back  to  Epinal  again  from  Mutzig, 

it  was  a  very  depressing  turn  of  events,  because  we  didn't  realize 
the  Germans  were  that  strong.   They  had  made  this  big  effort  to 
push  us  back.   It  was  one  gigantic,  final  effort. 

Hughes:   This  is  1944? 

Gerbode:   Yes,  1944.   So  anyway,  we  went  all  the  way  back  to  Epinal.   Then 

we  waited  there  for  a  while  until  the  Battle  of  the  Bulge  was  over, 
until  we  started  pushing  the  Germans  back  again.   We  had  to  go 
through  the  Hindenburg  Line,  so-called,  and  get  through  heavy 
fortifications. 


60 


Gerbode:  We  then  had  a  series  of  moves  up  into  eastern  France  and  western 
Germany.   We  moved  I  guess  three  times  into  villages  in  various 
places,  and  finally  ended  up  in  Heidenheim,  which  is  not  too  far 
north  of  Munich.  A  nice  little  village.   I  selected  this  place 
because  it  had  a  nice  field.  It  turned  out  to  be  kind  of  muddy 
later  on,  but  the  engineers  filled  it  in  with  rock  and  so  forth, 
so  it  wasn't  quite  so  bad. 

The  Germans  were  really  on  the  run  at  that  point  and  going  all 
the  way  back  into  the  Austrian  Alps  and  defecting  quite  frequently. 
We  had  a  German  colonel  walk  into  the  hospital  one  night  and  give 
himself  up.   I  could  talk  a  little  German.   So  I  talked  to  him  and 
asked  him  why  he  was  giving  up.   He  said,  "Well,  we're  going  to 
lose  the  war."  I  said,  "Why  do  you  think  [you're]  going  to  lose 
the  war?"  He  said,  "Because  of  that  two  and  a  half  ton  truck  of 
yours.   It  can  always  get  there  faster  than  we  ever  expect  you  to 
get  to  an  intersection  or  a  crossroad.   You'd  arrive  with  all  your 
guns  and  equipment  hours  before  we  thought  you  could  get  there, 
because  that  transportation  was  so  great."  Those  trucks  were 
marvelous.   They  were  fast  and  strong. 

Hughes:   Were  they  developed  during  the  war? 

Gerbode:  Yes,  they  were  a  war  product.  After  the  war,  we  saw  these  trucks 
all  over  everywhere,  because  people  wou.'.d  pick  them  up  right  away 
and  use  them.   Even  down  in  the  Hawaiian  Islands ,  a  lot  of  the 
plantation  people  bought  them  from  the  army  surplus  because  they 
were  so  useful  on  the  plantations.   They  are  so  strong  and  well 
made. 


Dachau 


Gerbode:  When  we  got  close  to  Munich,  I  really  got  more  and  more  interested, 
because  I'd  been  there  for  almost  a  year  before  the  war.   I  knew 
Munich  pretty  well.   When  we  got  word  that  Dachau  was  going  to  fall, 
I  got  permission  from  the  commanding  officer  to  get  a  jeep,  and  Roy 
Cohn  and  I  went  right  to  Dachau.  We  got  there  the  morning  after 
we'd  taken  it.   The  moat  around  Dachau  [contained]  about  a  dozen 
German  soldiers  [who]  had  been  killed  and  were  lying  in  the  water 
still.   The  people  in  Dachau  were  celebrating  as  best  they  could. 
They  had  some  improvised  flags  they  put  up.   The  army  brought  them 
food.   They  were  just  scarecrows,  just  skin  and  bones.   Whatever 
you  read  about  Dachau  is  not  exaggerated.   The  gas  chamber  room  was 
filled  with  bodies,  smoking  and  smoldering  because  they  had  run  out 


61 


Gerbode:   of  oil  to  burn  the  bodies,  so  they  just  stacked  them  in  this  big 
room  about  seven  or  eight  feet  deep,  one  on  top  of  the  other,  and 
smelling  pretty  awful.   [The  Germans  had]  taken  their  clothes  off, 
and  of  course  taken  all  the  gold  out  of  their  teeth  and  any  rings 
they'd  had.   Outside  of  the  gas  chamber  was  a  big  pile  of  bodies 
of  men,  women,  and  children,  just  skeletons  really,  piled  up  like 
cordwood.   Then  outside  was  a  couple  of  open  tank  cars  filled  with 
bodies  as  well.   Some  of  them  died  of  starvation;  some  of  them 
had  been  killed;  and  some  had  died  of  typhoid  or  typhus  or  various 
other  things.   If  anyone  disbelieves  this  happened,  they  shouldn't, 
because  it  was  really  true.* 

One  thing  I  can  say  for  the  Germans  is  that  they  have  documented 
this.   If  you  go  to  Dachau  now,  you  can  see  pictures  of  the  whole 
thing,  although  some  Germans  just  still  don't  want  to  believe  it. 
But  the  Germans  have  made  a  big  point  of  showing  actual  photographs 
of  how  they  did  everything,  the  places  where  [the  Jews]  had  to  sleep, 
and  how  they  killed  them  and  so  forth. 

Hughes:   Why  did  you  want  to  go?  Was  it  for  a  medical  reason? 

Gerbode:   No,  I  was  just  curious.   I  had  known  about  Dachau;  I  just  wanted 
to  see  it. 

Hughes:    It  was  well  known? 

Gerbode:   Oh,  yes.   Remember  I  told  you,  when  I'd  been  in  Germany  before,  my 
cook's  husband  had  been  sent  there. 


Munich 


Gerbode:   In  any  event,  Munich  fell  the  same  day  [I  went  to  Dachau].   So 

Dr.  Cohn  and  I  went  right  down  to  Munich.   I  found  the  little  house 
we  had  rented  in  Geiselgasteig.   It  was  in  a  forest,  a  beautiful 
location.   There  was  an  air-raid  shelter  dug  in  the  front  lawn. 
The  house  was  locked;  there  was  nobody  there.   I  looked  in  the 
window,  and  there  was  a  meal  unfinished  on  the  table.   The  people 
had  left  in  a  great  hurry. 

Hughes:   Where  did  people  like  that  go? 


*Partly  because  of  this  experience,  Dr.  Gerbode  contributed  to  the 
construction  of  the  statue  commemorating  the  holocaust,  which  stands 
near  the  Palace  of  the  Legion  of  Honor  in  San  Francisco. 


62 


Gerbode:   They  usually  went  further  into  the  mountains,  because  the  mountains 
were  close  by,  and  they  had  cabins  up  there  where  they  could  get 
away  from  the  scene  of  activity.   Then  we  went  down  to  Munich 
itself.   It  was  real  devastation.   The  center  of  the  town  had  been 
blasted  to  smithereens.   I  had  a  hard  time  finding  my  way  around. 
The  Frauenkirche  was  in  the  center  of  the  city.   I  finally  found 
it,  because  part  of  one  tower  was  still  standing.  From  there  I  could 
orient  myself  to  the  rest  of  it.   They  had  already,  after  some  of 
the  bombing,  built  little  stores  out  of  plywood  on  the  main  streets, 
so  they  could  do  a  bit  of  business  with  the  remaining  Germans 
before  the  Allies  came. 

I  knew  the  building  where  Hitler  had  had  his  headquarters  on 
a  great  big  square.  This  is  where  [Prime  Minister  Neville] 
Chamberlain  had  signed  the  appeasement  pact.   So  I  went  right  to 
the  building.   Since  I  was  a  lieutenant  colonel  at  that  point,  the 
army  sergeant  that  occupied  the  building  let  me  go  in.   So  I  went 
right  up  to  Hitler's  office,  and  there  was  a  sergeant  from  Texas 
with  his  feet  on  Hitler's  desk  and  this  great  big  room  lined  in 
pigskin.   Our  army  had  already  stripped  a  lot  of  the  pigskin 
leather  off  the  walls  for  souvenirs.   The  army  sergeant  was  there 
and  really  quite  happy  with  himself,  just  sitting  at  Hitler's  desk. 
He  said,  "Hi,  Doc,  you  want  a  souvenir?"  I  said,  "Sure."  He  said, 
"Well,  the  flag  from  the  building  is  in  Hitler's  bathtub  behind  me 
in  this  room."  So  I  went  in  there,  and  there  was  this  big  bathtub 
and  the  [flag]  which  they  had  taken  off  the  building.   He  gave  it 
to  me,  and  I  have  it  at  home  now. 

We  drove  around  a  little  just  to  see  the  devastation,  which 
was  really  awful.  We'd  really  bombed  the  smithereens  out  of  that 
town. 

Hughes:   Were  most  of  the  inhabitants  elsewhere? 


The  German  Surrender 


Gerbode:  They  were  elsewhere.  Hardly  anybody  was  left.  Once  in  a  while  an 
old  person  would  be  rummaging  around  in  the  debris.   So  then  we 
went  back  to  Heidenheim  and  waited.   The  Germans  were  really  giving 
up  here  and  there.   As  you  went  along  the  roads,  you'd  see  a  whole 
truckload  of  prisoners  being  brought  back  from  somewhere. 


63 


Gerbode:   Just  before  that  the  thing  that  was  so  obvious  [was]  that  we 

had  complete  dominance  of  the  air.   Every  night,  and  during  the 

day,  too,  these  huge  flights  of  British  and  American  bombers 

would  go  over  to  bomb  various  cities,  just  bombing  them  off  the 

face  of  the  earth.   That  was  the  only  way  you  could  get  [the  Germans] 

to  give  up,  really:   wreck  the  factories  and  the  towns.   They 

actually  went  after  the  center  of  the  towns,  too,  because  they 

had  to  get  the  people  to  realize  that  they  were  losing  the  war. 

•En  fact,  one  thing  that  happened  several  times  on  the  way  down 
through  western  Germany,  the  mayors  would  come  out  and  surrender 
the  village,  and  then  as  soon  as  our  troops  started  going  through, 
the  windows  would  open  on  the  second  floor,  and  the  SS  would  start 
shooting  at  the  troops.   They  killed  a  lot  of  our  soldiers  this  way. 
They  were  such  rabid  Nazis,  they  just  couldn't  believe  that  they 
were  going  to  lose  the  war.   So  then  our  commanding  general  said, 
"Look,  if  this  happens  once  more  after  the  village  has  surrendered, 
we're  going  to  back  off  and  level  the  town.   Nobody  is  going  to 
survive."   So  the  next  time  it  happened,  it  was  a  town  called 
Crailsheim.   It  was  a  modest  sized  town,  maybe  fifty  thousand 
people.   And  sure  enough,  the  SS  was  there  with  their  machine  guns. 
So  then_  the  general  pulled  everybody  out ,  surrounded  the  town  with 
tanks,  called  in  the  air  force,  and  they  absolutely  leveled  it.   I 
don't  think  there  was  even  a  chicken  alive.   But  that  was  the  last 
time  the  Germans  did  that.   That  was  the  only  way  you  could  deal 
with  it,  you  know.   We  went  through  Crailsheim  right  afterwards  on 
our  way  down  further  south — just  smoking  ruins. 

Hughes:   Would  you  do  anything  about  the  German  wounded? 

Gerbode:  Oh,  yes,  we'd  take  care  of  them,  just  like  the  Americans.   We  took 
care  of  a  lot  of  civilians  that  way. 

Hughes:   What  was  their  attitude? 

Gerbode:  Well,  at  that  point,  they  knew  the  game  was  up.   They  were  sad, 

dejected,  disillusioned  people.   This  was  even  true  of  the  soldiers, 
the  old  people  they  brought  in,  and  the  young  people;  they 
realized  that  it  was  hopeless. 

The  other  thing,  of  course,  is  the  German  air  force  was  wiped 
out.   We  could  never  find  Stucke  bombers  in  airports.   They  used 
the  Reich  autobahns  for  their  airstrips,  and  then  they'd  bring  the 
planes  into  the  forests  where  they  had  everything  camouflaged. 

II 


64 


Return  to  the  United  States 


Gerbode:  When  the  Germans  finally  gave  up,  I  was  lucky,  because  they  had 
a  system  of  points,  and  the  people  who  had  the  most  points  were 
allowed  to  go  home  first.   I  had  a  wife  and  three  children,  and  1 
had  been  in  from  the  very  beginning.   I  had  gone  through  all  these 
five  or  six  campaigns,  so  I  had  more  points  than  most  of  the 
others,  so  I  was  among  the  very  first  to  be  permitted  to  go  back. 

We  were  sent  back  to  Paris  and  put  up  in  the  Galerie  Lafayette, 
which  was  a  big  department  store  in  the  center  of  Paris.   It's 
still  there,  rebuilt.   The  Americans  had  taken  it  over.  They  had 
showers,  bunks  two  or  three  high,  where  we  slept  while  waiting  for 
evacuation.  We  were  there  for  about  a  week.  We  were  there  actually 
on  Bastille  Day,  which  is  always  a  big  celebration.   It  was  very, 
very  emotional  because  this  was  the  first  Bastille  Day  after  the 
Germans  had  been  defeated.   Some  friends  and  I  walked  all  the  way 
up  the  Champs  Elysee  with  the  crowds  of  people  celebrating  the  end 
of  the  war. 

I  went  back  to  the  Hotel  Crillon,  which  is  on  the  corner  of 
the  Place  de  la  Concorde  where  the  family  and  I  had  gone  a  couple 
of  times  before  the  war.   It  was  then  an  American  officers' 
rehabilitation  center  or  something  like  that.  They  had  an  orchestra 
so  that  the  Americans  could  dance  and  play  around  with  the  French 
girls  and  the  nurses.   I  went  up  to  the  desk  and  asked  the  steward 
if  he  knew  that  my  family  and  I  had  been  there  before,  and  he  said, 
"I'll  look  it  up."  He  found  our  old  bill.   [laughs] 

Finally  we  were  told  that  we  were  ready  to  leave  to  go  home. 
I  was  with  some  of  the  University  of  California  group,  who  had  a 
base  hospital.   Brodie  Stevens*  was  one  of  the  men  who  was  there  at 
the  same  time  waiting  to  be  evacuated,  along  with  some  of  the  other 
University  of  California  officers.   So  a  whole  bunch  of  us  were 
cart  ad  out  to  an  airstrip  and  put  in  a  C-54,  a  four-engine  motor 
plane,  and  started  home.  We  all  sat  in  metal  bucket  seats  around 
the  inside  of  the  plane.   We  were  given  evacuation  instructions  in 
case  we  went  down  in  the  ocean. 

We  were  going  from  Paris  to  Newfoundland  to  make  our  landing, 
and  about  three-quarters  of  the  way  across,  one  of  the  engines  in 
the  plane  went  crazy,  and  we  lost  thousands  of  feet  in  a  great  hurry. 


*Brodie  Stevens  was  a  surgeon  and  member  of  the  medical  faculty  of 
the  University  of  California,  San  Francisco. 


Above:   On  a  landing  craft  between  Sicily  and 
Italy,  1944. 

Right:   Off  to  war,  April  1942.   In  the  garden  at 
the  Gerbode  home  on  Divisadero  Street. 


Frank  and  Martha  Alexander  Gerbode  soon  after  his  return  from  war,  ca.  1945, 


65 


Gerbode:   So  we  were  all  told  to  get  ready  to  go  in  the  drink.   Brodie  Stevens 
said,  "Well,  Frank,  I  guess  this  is  it."  Luckily,  these  kids  who 
were  driving  the  plane — to  us  these  youngsters  looked  like  high 
school  students — managed  to  feather  this  crazy  engine  and  got  it 
under  control  so  they  could  get  it  into  Newfoundland.   We  were 
very  happy  to  land  safely.   [laughs]   That  was  really  something, 
to  think  that  we'd  go  down  in  the  ocean  after  going  through  all  this 
other  business  [during  the  war]. 

They  put  us  on  another  plane  in  Newfoundland,  and  finally  we 
got  to  New  York,  after  a  couple  of  transfers  of  airplanes.   My 
wife  met  me  there.   She  was  waiting  in  the  Gotham  Hotel.   We  had 
been  able  to  send  messages  saying  that  we  were  coming  home. 

The  thing  that  I  remember  so  clearly  on  arriving  in  New  York 
was  to  find  business  as  usual,  no  sign  of  any  suffering,  and  nobody 
really  seemed  to  care  very  much  about  the  war.   It  was  very  strange. 
And  the  same  thing  was  true  in  San  Francisco  later.   I  could  write 
another  little  chapter  about  the  attitude  of  the  people  that  didn't 
go  away  during  the  war. 

Hughes:   Could  you  say  something — not  a  whole  chapter — about  that? 

Gerbode:  One  of  them  that  didn't  go  away  said,  "We're  going  to  have  refresher 
courses  for  you  fellows  [who  have  come  back  from  the  war]  so  you  can 
remember  how  to  take  care  of  gall  bladders  and  hernias  and  so  forth, 
and  get  you  back  into  shape."  This  was  a  terrible  thing  to  say. 

Hughes:   Yes,  as  though  you'd  been  away  on  a  vacation. 

Gerbode:   We  looked  healthy,  because  we  were  all  slimmed  down  and  brown,  so 
they  thought  we  had  been  on  a  gigantic  vacation.   They  were  home 
taking  care  of  everything  and  really  suffering  terribly. 


Dwight  Harken 


Hughes: 


Gerbode : 


Dwight  Harken  crops  up  a  lot  in  talks  about  the  war.   Since  you  both 
were  more  or  less  in  the  same  field,  I  wondered  if  you  had  any 
contacts  with  him  or  knew  about  what  he  was  doing? 

Dwight  is  a  friend  of  mine.   He  was  with  a  Harvard  unit  which 
stayed  in  England  at  a  base  hospital,  so  he  got  a  lot  of  these 
patients  who  had  been  evacuated  by  hospitals  like  mine.   There  he 


66 


Gerbode:   was  one  of  the  first  to  demonstrate  that  you  could  remove  shell 
fragments  from  inside  and  around  the  heart  without  using 
extracorporeal  circulation.   He  did,  I  think,  several  hundred 
patients  this  way  with  very,  very  good  results,  the  first  time  that 
anyone  had  really  tackled  this  kind  of  surgery  with  such  success. 
It  really  made  him  quite  famous. 

Hughes:   Had  you  gone  into  the  war  with  the  feeling  that  the  heart  was 
surgically  inviolate,  so  to  speak? 

Gerbode:  No,  we  had  no  feelings  about  it  being  inviolate.   But  actually, 

if  a  shell  fragment  was  lodged  near  the  heart  and  the  soldier  was 
doing  well,  well  enough  to  be  evacuated,  we'd  send  him  back  with 
his  shell  fragment,  take  care  of  his  external  wounds,  because  most 
of  the  time  a  shell  fragment  in  or  around  the  heart  was  not  life- 
threatening  at  that  time.   Later  on  a  shell  fragment  would  erode 
parts  of  the  heart  and  patients  would  bleed,  or  they'd  get  infected, 
or  they'd  interfere  with  the  function  of  the  heart.   This  was  also 
true  of  the  boys  coming  back  from  Korea.  They  also  had  shell 
fragments  in  and  around  the  heart  which  had  to  be  removed  when  they 
came  back. 

Hughes:   But  you  didn't  have  to  do  that  in  World  War  II. 

Gerbode:  We  didn't  have  to  do  it  at  all.  We  did  take  out  shell  fragments  in 
the  chest  and  around  the  heart  if  they  were  causing  trouble  at  the 
time.   But  Dwight  really  did  a  magnificent  job  in  doing  this 
electively  in  England.  He'll  be  remembered  forever  because  of  the 
work  he  did. 

Hughes:   Yes,  I  read  that  he  removed  one  hundred  and  thirty-four  missiles 
without  one  death. 


Combat  Medals 


Hughes:   You  modestly  neglected  to  talk  about  the  combat  medals.   Could  you 
tell  me  a  little  bit  about  how  those  are  awarded? 

Gerbode:   It's  a  curious  system.   Combat  medals  are  awarded  because  you  were 
in  a  given  campaign.   Our  unit  ended  up  with  six  combat  medals. 

Hughes:   Per  person. 


67 


Gerbode:   Yes,  everyone  got  one.   It's  a  little  star  on  a  bar.   I  don't 

think  any  of  us  were  wounded,  so  none  of  us  got  a  purple  heart. 
But  there  were  several  medals  for  meritorious  work  that  were  given 
to  members  of  our  unit.   I  didn't  get  one. 

Hughes.    But  you  got  a  unit  citation. 

Gerbode:   Yes.   The  whole  unit  was  cited  for  having  contributed  such  a  lot  of 
good  work  during  the  war. 

Hughes:   When  they  say  good  work,  they  mean  in  the  medical-surgical  sense. 
Gerbode:   Yes. 

Hughes:    I  know  it's  hard  to  be  objective  when  you  were  part  of  it,  but  I've 
had  the  feeling  this  was  an  exceptional  unit. 

Gerbode:   It  was.   It  was  so  good,  because  we  had  all  been  academically 

trained,  we  all  had  gone  through  residencies,  we  knew  good  medicine 
and  good  surgery,  and  we  tried  to  apply  it  to  work  in  the  field, 
which  is  a  very  good  way  to  do  it.   We  were  so  good  that  they 
constantly  tried  to  break  us  up,  put  us  in  other  units.   But  most 
of  us  resisted  any  attempts  to  move  us.   If  the  question  came  up, 
we  said,  no,  we'd  rather  stay  with  our  own  group.   But  there  were 
two  or  three  surgeons  who  left  the  group  and  went  to  other  units. 


Other  Base  Hospital  Units 


Hughes:    I  saw  allusion  to  the  Fifteenth  Medical  General  Laboratory  which  in 
1943  was  apparently  moved  into  Italy.   I  don't  know  much  more  about 
it,  but  I  thought  maybe  since  you  were  there,  it  might  have 
influenced  what  you  were  doing. 

Gerbode:   There  were  several  big  base  units  that  were  moved  into — 
Hughes:   This  was  in  Naples. 

Gerbode:   Yes,  and  also  later  on  in  Rome.   For  example,  the  Harvard  General 
Hospital  I  think  moved  into  Naples  first  and  then  Rome  and  stayed 
there  during  these  final  pre-evacuation  treatments  of  patients. 
They  did  close  a  lot  of  the  wounds  secondarily  that  we  had  made 
originally  in  the  evacuation  hospital. 


68 


Hughes:   So  these  were  serving  the  same  function  as  Harken's  unit. 

Gerbode:  Yes,  except  they  were  closer  up  to  the  front.   In  fact,  [the 

Harvard  unit]  landed  in  Casablanca  very  shortly  after  we  landed 
there.  We  were  quite  jealous  of  them,  because  they  got  a  nice  big 
school  or  two  to  set  their  hospital  in,  and  they  had  a  lot  more 
amenities  than  we  did  out  in  the  field  in  our  tents,  including 
having  a  better  supply  of  liquor.   [laughter] 

Hughes:   That  was  very  important.  • 

Gerbode:   But  their  commanding  officer  was  not  very  popular.  He  was  an 

obstetrician.  Most  of  the  officers  hated  him.   I  won't  mention 
his  name.   There  were  a  couple  of  officers  in  that  Harvard  unit 
that  were  very  outspoken,  very  much  individuals,  and  they  were 
constantly  being  punished  by  this  commanding  officer.   I  had  some 
good  friends  in  this  unit.  One  was  Tygve  Gunderson.  We  rented  a 
double  bicycle  and  explored  the  countryside  around  Casablanca. 


The  Commanding  Officer 


Hughes:   You  didn't  have  a  problem  with  your  commanding  officer? 

Gerbode:  We  had  a  regular  army  surgeon  who  was  our  commanding  officer.  He 
was  not  at  all  well  liked  by  our  people.   I  got  along  with  him, 
because  I  didn't  think  there  was  any  point  in  antagonizing  him. 
Maybe  that's  why  I  got  all  these  little  extra  assignments.   It 
wasn't  because  I  expected  to  be  promoted  or  to  get  a  medal  for  it. 
I  just  didn't  want  to  be  inactive.   I  wanted  to  do  something 
constructive. 

He  was  an  orthopedic  surgeon  and  had  been  in  World  War  I.   He 
acted  as  though  the  war  was  just  another  experience  like  the 
previous  one  in  a  way.   But  he  was  very  high  in  the  hierarchy  of 
the  regular  army  and  may  have  had  some  influence  on  where  we  were 
sent  at  various  times. 

Hughes:   Was  he  dictatorial? 

Gerbode:  Well,  he  had  some  peculiarities.   For  example,  he  carried  with 

him  a  McGuffy's  Reader,  sort  of  like  a  Bible.   Do  you  know  what  a 
McGuffy's  Reader  is? 


69 


Hughes : 
Gerbode: 
Hughes: 
Gerbode: 


Hughes: 


Gerbode; 


It's  a  primer,  isn't  it? 

It's  a  children's  primer.   He  carried  this  all  during  the  war. 

What  was  that  for? 

I  don't  know  why  he  did  it.   Maybe  he  read  it  once  in  a  while, 
[laughter]   It  was  only  when  people  started  griping  and  complaining 
a  lot  that  he'd  get  cranky  and  do  things  that  they  would  dislike 
even  more.   To  me  that  was  kind  of  a  waste  of  time,  because  if  you 
weren't  acting  up,  he  would  leave  you  alone. 


That's  all  I  have  to  ask  about  the  war. 
to  say? 


Do  you  have  anything  more 


I  don't  really  have  anything  much  more  to  say  about  it.   I  said 
already  that  Harvey  Gushing  had  long  since  said  that  war  either 
makes  or  breaks  a  surgeon.   From  my  own  personal  point  of  view,  I 
guess  what  I  got  out  of  the  war  from  a  surgical  point  of  view  was 
confidence,  because  there  wasn't  anything,  really,  that  phased  me 
after  doing  all  that  work  in  the  war.   I  guess  that  you  get  used  to 
handling  all  kinds  of  situations. 


Correspondence  To  and  From  Home 


Gerbode:   From  the  point  of  view  of  hearing  from  home,  this  was  difficult, 
because  we  got  very  little  mail.   Once  in  a  while,  we'd  get  a 
batch  of  mail.   I  had  a  few  people  who  wrote  to  me  regularly.  Mrs. 
Happy  East  Miller,  a  very  lovely  older  woman  of  the  Miller  family 
in  San  Francisco,  wrote  to  me  regularly,  and  several  other 
acquaintances.   I  guess  they  enjoyed  writing  to  a  soldier  overseas. 
I  would  answer  their  letters,  and  they  would  go  through  all  right. 

Hughes:    I  wonder  if  any  of  those  letters  have  survived. 

Gerbode:   I  have  some  letters  that  I  wrote  at  home.   I  haven't  looked  at  them 
since  I  got  back. 

Hughes:   Don't  let  anything  happen  to  them! 

Gerbode:   I  wrote  a  lot  of  letters,  because  it  was  a  way  to  soak  up  time. 


70 


III  THE  IMMEDIATE  POSTWAR  YEARS 


Research  and  Surgery 


Decision  to  Stay  at  Stanford 


Hughes:   Then  you  were  back  as  an  instructor  in  surgery  at  Stanford.   Did 
you  ever  consider  going  anywhere  else? 

Gerbode:   I'd  had  offers  to  go  several  places  very  soon  after  I  got  back. 

The  army  asked  me  to  stay.   I  had  an  offer  to  go  to  New  York,  and 
an  offer  to  go  to  Washington,  D.C.,  and  a  couple  of  tentative 
offers  elsewhere. 

Hughes:   Did  those  offers  have  anything  to  do  with  your  wartime  experiences? 

Gerbode:  No,  it  was  the  fact  that  they  could  see  I  wanted  to  pursue  an 

academic  career.   I'd  written  a  few  papers  and  gotten — this  was  a 
few  years  after  the  war — to  be  known  a  bit.   But  I  turned  them  all 
down.   I  didn't  want  to  leave  San  Francisco.  No  matter  what  the 
honor  might  be  to  go  elsewhere,  it  didn't  mean  anything  to  me. 
Even  Palo  Alto  later  on.   [laughs] 

Anyway,  I  came  back  from  the  war  and,  as  I  said,  the  boys 
who  had  not  gone  away  said,  "Now,  we're  going  to  set  up  some 
refresher  courses  for  you."  That  was  one  thing,  and  another  group 
said,  "We  really  need  you  in  the  outpatient  clinic  to  work  with  the 
students."  This  again  was  like  a  kick  in  the  pants,  you  know. 
But  I  accepted  some  of  these  things,  and  I  went  to  the  outpatient 
clinic  a  little  of  the  time,  and  finally  got  back  on  the  team 
teaching  in  the  hospital.   But  mainly  I  went  right  back  to  work  in 
the  laboratory,  because  if  nobody  was  going  to  send  me  any  patients 


71 


Gerbode:   to  operate  upon  and  there  wasn't  much  else  to  do,  there  was  always 
a  lot  of  work  we  could  do  in  the  laboratory.  So  that's  when  I 
started  working  with  things  which  finally  led  to  extracorporeal 
circulation. 

Hughes:   Why? 

Gerbode:   Vascular  surgery  was  just  beginning  to  be  born,  and  I  could  see 
its  future  was  going  to  be  very  exciting  because  if  you  could 
correct  a  congenital  lesion,  you  usually  had  a  pretty  whole  person. 
The  choice  then  was  either  to  do  that  or  to  do  brain  surgery  or 
cancer  surgery.   Cancer  surgery  didn't  make  me  very  excited.   It's 
a  matter  of  cutting  out  a  lot  of  tissue  and  then  waiting  to  see 
whether  a  patient  was  going  to  get  [the  cancer]  back  again.  One 
of  the  professors  wanted  me  to  be  a  neurosurgeon,  and  he  tried 
everything  possible  short  of  killing  me,  which  is  really  true,  to 
get  me  to  be  a  neurosurgeon. 

Hughes:   This  was  [Reichert]  during  your  surgical  residency? 

Gerbode:   Yes.   It  was  really  something  to  cope  with  him,  because  he  was  a 

very  strong  man.   He  had  a  very  strong  wife,  who  had  decided,  too, 
that  this  would  be  best  for  her  husband,  to  have  me  be  a  neurosurgeon. 

Hughes:   Of  course  it  was  a  compliment.   [laughs] 


Simulated  Congenital  Lesions  and  Extracorporeal  Circulation 


Gerbode:   I  finally  just  said,  "No,  I  don't  want  to  do  that  at  all."   So  then 
I  started  making  simulated  congenital  lesions  in  animals  and  trying 
to  reduplicate  what  sometimes  happened  congenitally  and  then 
experimenting  finally  with  extracorporeal  circulation.   Some  of 
the  first  things  we  did  were  really  quite  curious.   For  example, 
the  first  oxygenation  we  did  was  to  put  the  venous  blood  in  bags 
with  oxygen  and  shake  them.   Then  we'd  get  the  blue  blood  to  turn 
pink,  and  then  we'd  give  that  back  to  the  animal.   This  was  the 
first  time  we  had  tried  to  do  anything  to  simulate  an  artificial 
lung.   I  did  this  with  John  Callaghan,  now  a  professor  in  Edmonton, 
Canada. 

Hughes:   This  was  right  after  the  war? 
Gerbode:   Late  '40s  and  early  '50s. 


72 


Hughes:   What  kind  of  success  did  you  have  with  that? 

Gerbode:   Pretty  good.   The  trouble  was,  we  didn't  realize  it  at  the  time, 
but  when  you  shake  the  blood  this  way,  a  lot  of  bubbles  get  in 
the  blood.   This  happened  later  on  when  we  got  into  using  bubble 
oxygenators  in  extracorporeal  circulation,  and  it's  still  a  bit 
of  a  problem  now.  Microbubbles  will  occur,  and  they're  not  very 
well  tolerated  by  the  body.  We  [did]  a  lot  of  experimental  work 
on  that  later  on  in  our  laboratory. 

We  had  a  good  diener  in  the  laboratory,  a  fellow  by  the  name 
of  John  Kratsch.  He  was  very  helpful  and  was  there  every  day  and 
very  good  at  helping  with  animals.   Later  on  another  Jewish  German 
emigre*  was  there  by  the  name  of  Ludwig.  He  got  to  be  very  good, 
too,  at  helping  with  animals. 

The  laboratory  that  I  went  back  to  in  the  old  [Stanford] 
medical  school  was  absolutely  infested  with  cockroaches  and  lice. 
Periodically  we'd  try  to  get  somebody  to  come  in  and  blitz  the 
place,  but  they  were  under  the  floors  and  in  the  drawers  and 
everthing.   During  the  war,  nobody  worked  in  the  laboratory.   It 
was  an  old  building,  and  the  bugs  and  beasts  just  took  over.   But 
we  finally  got  it  cleaned  up  reasonably  well.   When  you'd  bring 
the  animals  in,  they  were  usually  filled  with  ticks  and  lice.   They 
would  have  to  be  cleaned  up. 


Patient  Referrals 


Hughes:   How  were  you  faring  right  after  the  war  with  patient  referrals? 

Gerbode:  Oh,  few  and  far  between.   I  had  no  place  to  see  a  patient.  Although 
they  were  very  happy  [for  me]  to  be  an  instructor  and  work  in  the 
outpatient  clinic,  nobody  offered  to  give  me  a  place  where  I  could 
see  an  occasional  patient.   Frank  Norris,  who  had  not  gone  away  to 
the  war  and  who  was  a  gynecologist  here  in  town,  was  a  friend  of 
mine,  and  he  said,  "You  can  have  a  little  space  in  my  office  on 
Van  Ness  Avenue."  So  that's  where  I  went  once  or  twice  a  week 
just  to  see  if  somebody  would  come.   [laughter]   The  cases  that 
were  referred  to  me  were  breast  tumors  or  once  in  a  while  a  thyroid 
or  a  hernia  or  an  appendix.   But  I'm  very,  very  grateful  to  Frank 
Norris  for  giving  me  a  place  to  hang  my  hat. 


73 


Gerbode: 


Hughes : 
Gerbode; 

Hughes: 
Gerbode: 


Hughes : 
Gerbode: 


Hughes: 

Gerbode; 
Hughes : 

Gerbode; 

Hughes : 
Gerbode; 


Eventually,  as  I  worked  my  way  into  the  faculty  a  little  and 
became  useful  to  them — I  thought  I  was  useful  to  them  in  the 
beginning,  but  more  useful  to  them — they  gave  me  a  place  in  the 
old  Stanford  Hospital  where  I  could  see  patients  twice  a  week. 
But  then  the  dean  said,  "I  don't  really  want  you  to  send  any  cards 
announcing  that  you  have  an  office  here."   [laughs]   He  said,  "You 
can  see  patients  here,  but  don't  send  out  any  cards." 


He  was  a  rather 


What  did  he  think  would  happen  to  you? 

I  didn't  really  want  to  find  out  why  he  said  that, 
peculiar  man  anyway,  so  it  didn't  matter. 

How  did  that  situation  gradually  change? 

Well,  one  thing  that  changed  it  was  the  fact  that  Dr.  Holman  found 
I  was  a  good  assistant,  and  he  was  the  professor,  so  he  had  a 
pretty  large  private  practice.   So  did  Reichert,  the  neurosurgeon. 
They  needed  good  help  in  the  operating  room,  aside  from  the 
residents.   So  I  would  just  scrub  in  and  help  them,  and  then  finally 
once  in  a  while,  somebody  would  refer  a  case  to  me  instead  of  to 
them,  particularly  if  they  went  away.   [laughs] 

Was  that  all  right  with  them? 

They  couldn't  say  much  about  it.  If  the  boss  goes  away,  whoever  is 

left  behind  can  do  the  work  if  he  can  get  it.   This  is  generally 

true  in  all  medical  schools.   The  second  or  third  in  command  is 

always  very  happy  to  see  the  boss  leave. 

This  sort  of  thing,  I  would  imagine,  always  happens  to  a  younger  man 
trying  to  break  into  a  field,  but — 

It  does. 

— the  fact  that  you  had  been  away  and  they  hadn't  would  aggravate 
that  situation. 

Yes.   The  other  thing  is  that  there  were  quite  a  few  people  who 
hadn't  gone  away,  you  see,  and  they  had  most  of  the  practice. 

Yes. 

Holman  went  away  to  the  navy,  and  Reichert  didn't.   Holman  served 
very  well  in  the  South  Pacific  and  at  Mare  Island.   But  when  he 
returned  he  was  the  professor,  the  chief,  so  he  had  no  problem 
getting  patients  again.   Reichert  had  stayed  home,  and  I  must  say. 


74 


Gerbode:   it  was  terribly  hard  on  him.  He  was  very  conscientious  about 
teaching  and  his  responsibilities  to  the  house  staff.   So  he 
worked  really  hard,  almost  to  the  point  of  becoming  a  little  bit 
psychotic  sometimes,  I  thought,  under  the  pressure.   This  carried 
over  later  on  when  Dr.  Holman  came  back  and  took  over.   Then 
Reichert  was  not  the  big  chief  any  more,  and  this  was  a  little  bit 
of  a  problem,  too. 

Then  when  we  began  to  do  heart  surgery,  Dr.  Holman  liked  to 
have  me  assist,  because  f  was  a  pretty  good  assistant.   I  had 
already  done  most  of  the  procedures  in  the  dog  lab,  because  I  was 
constantly  working  over  there  with  all  my  free  time,  doing 
experimental  procedures  on  animals.  Managing  blood  vessels  and 
things  around  the  heart  was  becoming  quite  familiar  to  me.   So 
gradually  I  just  got  a  few  of  these  patients. 

Hughes:   These  were  mainly  congenital  anomalies? 

Gerbode:  These  were  congenital  anomalies,  but  not  open  heart  surgery.   These 
were  procedures  like  doing  patent  ductus  and  coarctation  and  the 
Blalock  procedure,  which  came  along  a  little  later. 


Early  Vascular  and  Heart  Surgery  in  the  United  States//// 


Gerbode:   [What]  first  pushed  vascular  surgery  and  then  heart  surgery  forward 
in  this  country  was  the  access  that  young  university  men  had  to 
the  laboratory,  and  the  fact  that  if  they  had  made  a  name  for 
themselves  in  the  experimental  laboratory  and  could  present  papers 
at  meetings,  this  was  very  good  for  their  record  and  promoted  them 
in  the  faculty  almost  faster  than  anything. 

Hughes:  Now,  was  this  unusual? 

Gerbode:  This  was  more  or  less  American. 

Hughes:  Not  British. 

Gerbode:  No.   The  British  frowned  on  experimental  surgery. 


75 


Robert  Gross:   Operations  for  Patent  Ductus  and  Coarctation 


Gerbode: 


Hughes: 
Gerbode: 


Hughes: 
Gerbode: 

Hughes: 
Gerbode : 


Anyway,  there  were  two  men  in  our  country  who  really  pushed  things 
forward,  and  they  were  both  men  who'd  worked  a  lot  in  the  laboratory. 
One  was  [Robert]  Gross  in  Boston,  who  did  the  first  patent  ductus 
arteriosus.   Dr.  Holman  had  been  offered  a  patient  to  operate 
upon  a  patent  ductus  before  this  by  Bill  Dock,  who  was  then  on  the 
medical  faculty,  but  [Holman]  turned  the  patient  down.   He  didn't 
want  to  do  it  for  some  reason.   So  then  he  lost  a  chance  to  become 
immortal.   But  Gross  did  one,  and  he  ligated  it  successfully.   There 
had  been  a  couple  of  attempts  before,  and  they  had  failed.   But  his 
patient  survived,  and  he  was  working  in  a  hospital  where  there 
were  children  with  all  kinds  of  defects,  and  so  he  had  lots  of 
material.   He  immediately  did  a  whole  batch  of  patients  with  patent 
ductus. 

He  was  from  Boston? 

He  was  at  Children's  Hospital  in  Boston.   He  worked  with  Charlie 
Hufnagel  in  the  laboratory.   Between  the  two  of  them,  they  had  made 
experimental  coarctation  and  perfected  an  operation.  About  the 
same  time  that  Clarence  Crafoord  in  Stockholm  had  done  a  successful 
coarctation  [October  19,  1944],  they  had  done  one  in  Boston  [June  28, 
1945].   This  also  caused  tremendous  excitement. 


And  then  you  did  one  noc  long  thereafter, 
it  in  1951. 


You  published  a  paper  on 


Yes,  I  did  some  very  early.   I  did  the  first  patent  ductus  at 
St.  Bartholomew's  Hospital  in  London  in  1949. 

Yes,  I  read  that  paper — a  young  boy  with  a  psychiatric  problem. 

That  was  a  coarctation.   Christopher  Frye.   He  became  a  doctor  at 
St.  Bartholomew's  later,  and  I  saw  him  in  London  when  I  was  over 
there  recently. 


The  Blalock  Procedure 


Gerbode:   Anyway,  Blalock  had  also  been  experimenting  on  animals  to  try  to 
correct  coarctation.   He  really  didn't  think  he  could  cut  out  the 
coarctation  and  sew  the  ends  together. 


76 


Hughes:   Why? 

Gerbode:  He  said  later,  "The  reason  I  didn't  think  of  doing  it  that  way 

was  because  I'd  never  seen  a  coarctation.   I'd  only  seen  pictures 
of  them." 

What  he  did  then  was  to  turn  down  the  left  subclavian  artery 
into  the  area  beyond  the  coarctation  to  make  kind  of  a  bypass 
operation.  He  didn't  realize  it  at  the  time,  but  this  was  an 
operation  which  later  became  the  Blalock  procedure  for  blue  babies. 
That  was  a  tremendous  thing.   It  is  said  that  Helen  Taussig 
persuaded  him  [Blalock]  to  do  this,  because  she  had  seen  Gross 
produce  an  artificial  ductus  by  sewing  the  subclavian  artery  into 
the  pulmonary  artery,  and  that  produces  the  same  physiology  as  a 
patent  ductus.   So  she  knew  that  blue  babies  who  had  tetralogy 
of  Fallot,  who  had  a  patent  ductus,  did  well.   Then  if  the  patent 
ductus  closed,  the  children  would  die.   She  then  rightfully  said, 
if  we  can  make  a  patent  ductus,  then  we  can  keep  some  of  these  blue 
babies  alive.   She  persuaded  Blalock  to  try  it.  He  had  a  very  fine 
black  man,  Julian,  working  in  the  laboratory  who  helped  him  a  great 
deal.  He  was  terribly  good  with  his  hands.  He  and  Al  worked  on 
this  operation  for  blue  babies. 

Hughes:   You  mean  he  would  actually  assist  Blalock? 

Gerbode :  Yes ,  and  they  worked  together  in  the  lab .   Julian  got  so  good  at  it , 
I  think  he  was  doing  it  very  well  himself. 

Hughes:   Did  you  subsequently  do  some  of  those  operations  yourself? 

Gerbode:  Oh,  yes,  I  did  maybe  a  hundred  or  so.  When  I  went  to  England  in 

'49,  I  did  this  operation  and  nobody  else  [there]  was  doing  it  very 
much. 

There  were  thousands  of  blue  babies  in  this  country  and  in 
Europe.   This  was  the  first  operation  that  came  along  that  could 
help  them  at  all,  so  that  everybody  was  trying  to  do  these  blue 
baby  operations  after  they  knew  a  little  bit  about  the  field.  Dr. 
Holman's  wife  was  named  Dr.  Ann  Purdy,  and  she  was  a  pediatric 
cardiologist.   She  had  a  bunch  of  these  children  on  a  string.   She 
developed  a  tremendous  practice  and  fed  these  patients  to  Dr.  Holman, 
and  I  was  helping  Dr.  Holman.  As  time  went  on,  once  in  a  while 
she'd  slip  me  one,  too.   [laughs]   If  it  went  well,  then  that  was 
fine. 

Hughes:   The  success  rate  in  the  beginning  was  not  all  that  high,  was  it? 


77 


Gerbode:   The  mortality  rate  wasn't  so  very  great,  maybe  5  or  6  percent. 
Hughes:   Most  of  these  children  were  terribly  sick,  were  they  not? 

Gerbode:   They  were  very  blue.   Well,  most  of  them  were  not  very  well 

developed,  because  they  hadn't  been  able  to  run  or  play  very  much. 
But  they  blossomed  with  this  operation. 

Anyway,  with  [Clarence]  Crafoord's  operation  for  coarctation, 
Gross's  operations  for  patent  duct us  and  coarctation,  and  Blalock's 
developing  the  Blalock  procedure,  this  caused  a  tremendous  amount 
of  excitment.   Then  everybody  started  trying  to  find  other  things 
to  do.   The  ones  who  could  were  better  off.   These  were  usually 
ones  who  had  worked  a  lot  on  experimental  animals  in  the  dog  lab. 
This  was  generally  true  of  the  young  academic  surgeons.   Now,  the 
other  thing  that  contributed  to  this  a  bit  later  was  the  fact  that 
a  lot  of  these  young  faculty  members,  like  me,  didn't  have  much  to 
do  when  they  came  from  the  war.   [laughter]   So  we  were  working  in 
the  lab  anyway  to  keep  busy. 

Hughes:    So  it  was  a  blessing  in  disguise. 

Gerbode:   They  were  the  ones,  then,  who  pushed  the  field  forward.   Harken 
was  one.   He  very  quickly  started  doing  these  mitral  valve 
operations.   He  was  accepted  as  a  thoracic  and  heart  surgeon 
because  of  his  war  record. 


Factors  in  the  Advance  of  Thoracic  Surgery 


Hughes:   Would  you  say  something  now  about  some  of  the  other  things  that 
were  coming  along  that  were  essential  to  the  advance  of  thoracic 
surgery? 


Endotracheal  Anesthesia 


Gerbode:   There  was  a  great  deal  of  activity  in  thoracic  surgery.   In  fact, 
because  of   endotracheal  anesthesia,  surgeons  were  able  to  control 
an  open  chest  operation  much  better  than  they  could  before  [the 
war],  when  we  didn't  have  very  good  anesthesia,  didn't  have 
anesthesiologists  who  could  manage  patients  with  an  endotracheal 
tube. 


78 


Hughes:   Was  that  a  war  development? 

Gerbode:  The  war  pushed  it  forward  a  lot.  When  the  young  surgeons  found 
they  could  do  so  many  operations  in  the  chest,  there  were  papers 
at  all  the  meetings,  transthoracic  this  and  transthoracic  that. 
One  of  my  friends,  who  was  mainly  a  cancer  breast  surgeon  in  Boston 
said,  "I've  got  to  figure  out  how  to  do  a  transthoracic  breast 
amputation."   [laughter]   "It  would  be  worth  a  lot." 

Hughes:   That's  lovely. 

Gerbode:  He's  a  wonderful  guy.  We  had  a  lot  of  fun  together  in  Africa. 

[interruption] 
Hughes:   You  were  talking  about  anesthesia. 

Gerbode:  Yes,  the  anesthesia  improved  enormously,  and  the  anesthesiologists 
learned  how  to  manage  patients  with  an  endotracheal  tube.   This 
was  very  important.  They  mainly  did  it  with  their  hands  at  that 
time.   They  had  bags  which  they  would  squeeze  to  bring  about  a 
respiratory  movement. 

Hughes:   Was  the  anesthesiologist  a  member  of  the  surgical  team  on  a  par  with 
everybody  else? 

Gerbode:  The  anesthesiologists  were  not  quite  that  far  along.  Wall,  in 
1 49  and  ' 50 ,  they  began  to  become  very  important . 

Hughes:   The  British  have  a  history  of  using  different  sorts  of  anesthetics 
than  the  Americans;  at  least  that's  the  way  it  started  out. 


The  Engstrom  Volume  Respirator 


Gerbode:  Yes,  but  I  think  the  biggest  advances  in  the  open  chest  work  came 
from  the  Swedes,  because  they  are  the  ones  who  developed  one  of 
the  first  artificial  respirators,  the  Engstrom  respirator.   That 
came  out  really  because  Engstrom  was  an  engineer ,  and  he  had  another 
fellow  who  was  a  physiology  engineer  who  worked  with  him.   These 
were  patients  who  had  very  bad  trauma  to  their  lungs  in  automobile 
accidents,  and  there  wasn't  any  way,  really,  to  keep  them 
going  without  some  kind  of  artificial  respiration.   For  a  long  time, 
they  had  to  have  a  nurse  stand  there  and  use  a  bag  to  respire  for 
the  patient.  Those  who  had  polio  and  were  paralyzed  and  couldn't 
breathe  were  put  in  the  so-called  iron  lung.  This  is  a  machine  where 


79 


Gerbode:   the  head  stuck  out  of  the  end,  and  they  had  a  rubber  collar  around 
the  neck.   The  inside  of  it  would  expand  or  contract  the  chest  by 
negative  or  positive  pressure.   We  had  one  of  these  machines  over 
here  and  used  it  for  a  while  on  polio  patients,  but  that  was  a 
terrible  way  to  do  it. 

Anyway,  the  Engstrom  respirator  was  a  volume  respirator.   It 
would  take  over  the  patient's  respiration  for  long  periods,  months. 
It  was  a  big  advance. 

I  got  to  know  the  Swedes  pretty  well.   I  had  been  over  there 
a  few  times.   In  '49  I  went  over  there  from  England  and  saw  this 
machine  in  operation.   When  I  came  back,  I  said  we  need  to  get  an 
Engstrom  unit,  which  seemed  to  me  much  better  than  having  the 
anesthesiologist  stand  there  squeezing  the  bag  during  the  whole 
operation.   The  anesthesiologists  said,  "We  can  tell  much  better 
by  the  feel  of  the  bag  whether  we're  doing  a  good  job  or  not."  I 
said,  "You  may  think  that,  but..." 

There  was  only  one  anesthesiologist  who  was  willing  to  try 
one  of  these  machines.   I  got  my  friend  Viking  Bjork  to  send  me  a 
second-hand  one.   I  didn't,  have  enough  money  to  buy  a  new  one,  but 
he  gave  me  one  which  was  about  a  year  old  and  had  it  shipped  over. 
I  gave  him  what  he  thought  was  a  fair  price  for  it.   Everybody  in 
the  place  was  scared  to  death  of  it.   My  associate,  Dr.  [John] 
Osborn,  after  we'd  been  experimenting  with  it  for  a  while,  wrote  me 
a  memorandum  telling  me  he  thought  it  was  a  dangerous  machine  that 
was  killing  patients,  and  we  shouldn't  ever  use  it. 

Hughes:   Was  it  killing  patients? 

Gerbode:   No,  it  was  saving  patients.   The  chief  of  anesthesiology,  [Philip] 
Bailey,  wouldn't  use  it.   One  anesthesiologist  by  the  name  of 
[Ernest]  Gianotti  finally  was  willing  to  try  it,  and  he  began  to 
use  it  very  successfully. 

Later  on  they  were  still  not  convinced,  so  I  brought  over  the 
engineer  and  professor  of  anesthesia  from  the  Karolinska  Institute 
in  Stockholm.   I  got  money  enough  to  pay  for  them,  to  bring  them 
over  to  keep  them  here  for  a  couple  of  months  to  work  in  the 
intensive  care  unit,  in  postoperative  care,  and  also  in  the 
operating  room.   They  finally  were  able  to  demonstrate  that  the 
machine  was  a  big  advance.   We  were  the  first  unit  in  the  country 
to  use  the  volume  respirator  clinically. 


80 


Gerbode:  There  was  another  group  who  came  along  very  soon  afterwards.   That 
was  [William  Henry]  Muller  and  Dammon,  who  was  then  in  Virginia. 
They  had  been  in  California.   They  saw  the  light,  too,  and  began 
to  use  [the  Engstrom  respirator]  and  wrote  some  papers  on  it. 

About  this  time  I  went  to  [the  Peter  Bent]  Brigham  Hospital, 
where  Dwight  Harken  was  then  operating  on  quite  a  few  mitral 
patients.   They  had  a  postoperative  recovery  room.   I  noticed 
that  they  were  using  pressure  respirators,  which  were  made  by 
Bird,  a  California  outfit.  We  used  a  lot  of  them,  too.   They're 
not  bad,  but  they're  not  as  good  as  the  volume  respirator.   They 
were  sort  of  a  poor  man's  respirator.   I  said  to  Franny  Moore,  "I 
think  that  you  ought  to  get  interested  in  volume  respirators." 
He  said,  "Write  me  a  letter  about  it."  So  I  wrote  him  a  letter,  and 
he  wrote  me  back,  "I've  turned  this  over  to  my  chief  of  anesthesiology , 
and  I'll  send  you  back  a  report  later."  So  what  he  did,  like  a 
general,  he  said,  "Now,  you  study  this  and  tell  me  whether  you 
think  it's  any  good  or  not."  After  a  couple  of  months,  he  sent  me 
a  letter  and  he  said,  "I've  turned  this  over  to  Dr.  So-and-so  in 
anesthesia,  and  he  has  studied  the  matter  and  believes  [volume 
respirators]  are  dangerous  and  shouldn't  be  used."  But  they  all  use 
them  now.   [laughter] 


Advances  Affecting  Cardiovascular  Surgery//// 
[Interview  4:  August  10,  1983] 

Cardiac  Catheter izat ion 


Gerbode:  One  of  the  essential  aspects  of  doing  cardiac  surgery  is  cardiac 
catheterization.  As  you  know,  one  team  got  a  Nobel  Prize  for 
developing  cardiac  catheterization.*  Then  young  people  were  being 
trained  in  the  technique.   It  was  apparent  that  in  order  to  carry 
cardiac  surgery  forward,  you  had  to  have  a  cardiac  catheterization 
laboratory. 

It  was  my  job  to  get  this  done  at  the  old  Stanford  Medical 
School.   It  was  very  difficult,  because  we  had  to  have  a  room  with 
a  certain  amount  of  equipment,  in  addition  to  getting  someone  to  do 


*Werner  Forssmann,  Dickinson  Richards  and  Andre  F.  Courland  received 
the  Nobel  Prize  in  medicine  in  1956  for  discoveries  concerning  heart 
catheterization  and  pathological  changes  in  the  circulatory  system. 


81 


Gerbode:   the  work.   It  was  very  difficult  to  get  this  room  [from]  the 

administration.   The  people  in  control  of  the  rooms  were  not  quite 
sure  whether  this  was  going  to  be  a  big  thing  or  not,  and  people 
like  to  hang  on  with  great  enthusiasm  to  their  territorial 
acquisitions  in  any  setup.   So  I  finally  got  a  storage  room  in  the 
basement  to  start  the  lab.   Then  we  bought  some  catheters  and  used 
them  on  experimental  animals  first  of  all.   Then  as  time  went  on, 
we  found  Herbert  Hultgren  on  the  East  Coast,  who  was  trained  in 
cardiac  catheterization.   He  got  a  fellowship  to  come  out  and  start 
the  lab. 

Hughes:   Excuse  me  for  interrupting  you,  but  with  a  technique  so  relatively 
new,  how  would  Hultgren  have  received  training? 

Gerbode:   He  trained  with  some  people  in  the  East  who  had  one  of  the  early 
catheterization  laboratories. 

Hughes:   Where  was  he? 

Gerbode:   He  was  trained  [at  Thorndike  Memorial  Laboratory,  Boston]. 

Hughes:   So  there  were  a  few  institutions  that  did  cardiac  catheterization. 

Gerbode:   There  were  a  few  institutions  that  had  already  started,  that's 
right. 

So  [Hultgren]  came  out.   I  think  it  was  the  Giannini  Foundation 
that  paid  his  fellowship.   But  the  amount  they  were  willing  to  pay 
for  a  fellowship  at  that  time  was  pretty  small.   However,  he  was 
willing  to  accept  it  as  a  starter.  Then  we  had  to  get  money  for 
technicians  as  well ,  because  somebody  had  to  do  the  blood  chemistries 
on  the  blood  samples.   We  found  money  here  and  there  to  do  that. 

Dr.  [Arthur]  Bloomfield,  who  was  professor  of  medicine  at 
that  time,  said,  "Well,  we  shouldn't  charge  anybody  for  this  test 
the  first  year,  because  it's  an  experimental  procedure.  We  have 
to  do  it  for  nothing."  Which  shows  you  how  tentative  the  faculty 
members  can  be  with  new  things.   They  have  to  go  ahead  very 
cautiously. 

Hughes:   Because  it  was  experimental,  in  those  days  did  you  have  to  get 
any  special  patient  consent? 

Gerbode:   No.   At  that  time  we  didn't  have  to  go  through  the  business  of 

getting  informed  consent.   However,  we  would  tell  patients  anyway 
what  the  risks  were.   But  the  risks  were  practically  nil  anyway. 
The  patients  were  very  anxious  to  find  a  proper  diagnosis. 


82 


Gerbode:  The  first  operations  we  did  were  simpler  ones,  like  patent  ductus 
and  coarctation,  but  later,  as  I've  indicated  previously,  we  got 
into  operating  on  blue  babies,  too.   We  had  a  very  nice  doctor  in 
physical  therapy  by  the  name  of  [Fred]  Northway.   He  had  virtually 
a  whole  floor  in  the  medical  school  devoted  to  physical  therapy, 
and  I  finally  persuaded  him  to  give  up  one  room  for  a  cath  lab.  We 
moved  from  the  basement  to  this  room.  Again,  it  was  pretty 
primitive  stuff.  We  had  to  use  a  portable  xray  to  watch  where  the 
catheter  was  going,  and  that  wasn't  very  satisfactory. 

Hughes:   Was  this  done  under  local  anesthetic? 

Gerbode:  Yes.   It's  very  simple. 

Hughes:   A  child  will  lie  still  long  enough  for  that? 

Gerbode:  Yes,  the  children  really  are  quite  good  about  it.  Later  on  we  had 
to  use  a  light  general  anesthesia  for  some  of  the  cases,  but  not 
very  often. 

Hughes:   It's  not  terribly  painful  then? 

Gerbode:  No,  it  isn't.  As  soon  as  we  were  able  to  operate  upon  these 

children,  then  we  had  a  lot  more  patients  offered  for  study.   The 
administration  finally  began  to  realize  that  this  was  something 
important,  [and]  they'd  better  get  on  with  it.   Hultgren  did  a 
very  good  job  of  getting  it  started. 

Hughes:   Could  you  explain  exactly  how  catheterization  helped  diagnosis? 

Gerbode:  The  simplest  explanation  is  that  you  put  a  long  tube  in  an  arm 

vein,  thread  it  up  into  the  heart,  and  then  you  take  blood  samples 
in  the  heart,  and  you  measure  pressures  in  the  heart.  You  measure 
pressures  because  if  there  is  a  blockage  in,  say,  the  pulmonary 
artery,  and  you  have  the  catheter  in  the  right  ventricle,  the 
pressure  is  very  high.  You  can  sometimes  get  it  through  the  valve 
into  the  pulmonary  artery,  and  then  you  can  see  the  difference 
between  the  two  pressures. 

Hughes:   The  name  Helen  Taussig,  of  course,  stands  out  in  this  area;  how 
was  she  doing  diagnosis  before  cath  labs  were  established? 

Gerbode:  Mainly  on  physical  examination  and  xrays. 
Hughes:   How  did  she  do  that? 


83 


Gerbode:   Well,  there  was  quite  a  bit  of  science  and  history  connected  with 
making  a  diagnosis  without  catheterization  in  congenital  heart 
disease.   You  could  tell  by  the  contour  of  the  heart  and  the 
physical  findings,  the  sound  of  the  heart.   You  could  tell  pretty 
well  the  general  category  of  the  type  of  congenital  anomaly  there 
was.   Then  they  had  a  lot  of  hearts  to  examine  postmortem,  because 
a  lot  of  these  children  were  dying.   So  they  were  very  careful  to 
do  postmortem  examinations  on  them.   They  developed  quite  a  science 
of  correlating  what  they  had  seen  preoperatively  or  before  the 
child  died  with  what  they  found  in  an  autopsy.   You  can  do  a  pretty 
good  job  of  guessing  what's  wrong  that  way. 

But  coming  back  to  catheterization,  the  other  thing  the 
catheter  would  do,  you  could  take  a  blood  sample  from  the  chambers 
of  the  heart,  and  if,  for  example,  you  found  the  oxygen  saturation 
in  the  right  atrium  very  high,  as  compared  with  a  vein,  then  there 
is  certainly  mixing  of  arterial  blood  with  it.   This  meant  that 
there  was  a  shunt  somewhere,  a  hole  between  the  two  sides  of  the 
heart.   If  you  found  the  step-up  oxygen  saturation  to  be  in  the 
right  ventricle,  and  it  wasn't  so  much  on  the  right  atrium,  then 
that  meant  the  shunt  was  between  the  two  ventricles.  There  were  also 
pressure  differences,  too,  when  there  was  a  shunt  from  left  to 
right  in  the  ventricle. 

Hughes:    [Werner  Forssmann  inserted  a  catheter  into  his  own  heart  in  1929.] 
I  was  just  wondering  why  it  took  so  long  for  the  technique  to 
catch  on. 

Gerbode:   Because  people  shuddered  at  the  thought  of  sticking  something  up  the 
vein  into  the  heart.   It's  like  murdering  your  sister  or  something. 
It's  the  same  idea  as  you  can't  touch  the  heart  and  operate  upon  it. 
You're  doing  something  which  everyone  said  would  never  be  possible 
or  should  never  be  done. 

Hughes:   So  really,  one  reason  that  catheterization  came  into  general 

practice  after  the  war  was  because  the  heart  was  by  then  considered 
touchable. 


Rapid  Xray  Film  Changers 


Gerbode:   Yes.   It  was  not  inviolate  any  more,  and  they  found  out  they  could 
do  it  repeatedly  and  not  harm  anybody.   So  this  made  it  very  much 
more  acceptable.   Later  on,  of  course,  we  began  to  inject  dye  into 


84 


Gerbode:  the  heart  through  the  catheter  and  take  pictures,  but  that's 
another  story,  because  there  weren't  any  rapid  film  changers 
available  when  we  started,  and  we  had  to  work  on  fixing  one  up 
ourselves.   So  we  made  the  first  rapid  film  changers  in  our  own 
laboratories  here. 

Hughes:   This  is  for  xrays? 
Gerbode:  Yes. 

Hughes:   Because  then  there's  a  later  stage  with  radioisotopes,  is  there 
not? 

Gerbode:  Yes.   That's  much  later.   But  anyway,  just  to  inject  dye  into  the 
heart  and  follow  it  through  with  serial  rapidly  changing  xrays 
could  tell  you  where  there  was  a  hole  or  tell  you  where  there 
[was]  obstruction. 

Hughes:   When  did  that  technique  come  in? 

Gerbode:  This  is  all  about  the  same  time.   Luckily,  there  was  a  young  fellow 
in  the  xray  department  who  was  a  pretty  good  engineer,  and  we 
worked  with  him  to  develop  the  first  film  changers.   I  had  to 
push  the  film  through  manually  in  the  first  ones.   In  fact,  I've  got 
some  little  white  spots  on  my  hand  from  having  too  much  xray. 

Hughes:   Overexposure. 

Gerbode:  Yes,  overexposure.   But  none  of  these  turned  to  cancer. 

Hughes:   When  you're  doing  something  like  that,  is  the  xray  beam  continuously 
on? 

Gerbode:   It  goes  on  and  off,  but  it's  pretty  continuous,  because  it's  so 
quick,  you  see.   But  we  had  aprons  on  to  protect  ourselves. 
Anyway,  it  wasn't  until  quite  a  bit  later  that  the  commercial  film 
changer  became  available. 

Hughes:  I  saw  a  reference  to  thorotrast. 

Gerbode:  Yes,  thorotrast  was  the  dye  they  were  injecting. 

Hughes:  That's  a  thorium  compound,  isn't  it? 

Gerbode:  Thorium.   And  it  has  iodine  in  it.   I  don't  know  the  exact  chemistry. 


85 


Hughes:    I  thought  thorium  was  a  no-no  by  then  because  of  the  danger  of 
radiation  damage  and  cancer. 

Gerbode:   [It  was  later  stopped  because  it  was  absorbed  by  the  spleen  and 
other  organs  and  was  thought  to  be  carcinogenic.]* 

We  used  that  catheterization  unit  for  a  number  of  years.   They 
took  the  old  machine  down  to  [Palo  Alto]  when  Stanford  moved,  which 
was  just  as  good,  because  then  we  were  able  to  get  a  more  modern 
one  here .   As  luck  would  have  it ,  a  very  wealthy  man  came  into  the 
hospital  with  heart  disease  around  that  time,  and  he  appreciated 
very  much  how  well  he'd  been  treated,  not  surgically,  but  medically. 
He  said,  "What  do  you  need  now  that  Stanford  is  moving  to  Palo  Alto?" 
We  said,  "We  need  a  modern  angiocardiographic  machine,"  which  then 
cost  about  eighty  thousand  dollars,  I  believe.   He  said,  "All 
right."   So  he  gave  us  the  newer  model.   We  came  out  all  right  on 
that  one. 

Hughes:    [laughs]   I  bet  the  people  at  Stanford  were  hating  themselves! 

Gerbode:   Yes.   But  since  then  they've  done  very  well.   They  have  everything 
they  need  down  there,  so  there's  no  worry  about  them. 


Blood  Transfusion 


Hughes:   What  about  techniques  for  rapid  blood  transfusion? 

Gerbode:  There  wasn't  anything  really  special  about  rapid  transfusion. 
The  blood  came  in  bags,  and  you'd  just  squeeze  [blood]  into  a 
vein  by  squeezing  the  bag.  Or  you  could  put  a  blood  pressure 
cuff  on  the  bag  and  pump  it  up  and  squeeze  it  that  way,  which 
works  very  well. 

Hughes:   These  were  techniques  that  you'd  been  using  before  the  war  as  well? 

Gerbode:   Yes.   The  blood  bank  here  in  San  Francisco  [Irwin  Memorial  Blood 
Bank]  has  always  done  a  fantastic  job.   [San  Francisco]  was  among 
the  first  to  have  a  voluntary  blood  bank,  because  of  the  war  in  the 
South  Pacific. 


*Dr.  Gerbode  added  this  comment  later  in  the  course  of  editing. 


86 


Hughes:   Where  did  blood  come  from  before  the  war? 

Gerbode:   It  came  from  the  same  place,  but  it  was  on  a  very  small  scale. 
I  can  remember  when  there  was  one  man  in  town  who  was  very  good 
at  giving  a  blood  transfusion.   He  made  a  living  on  going  around 
to  hospitals  giving  transfusions,  just  because  he  could  cut  down 
a  vein  and  get  a  needle  in  it.   He  became  a  specialist  in  just 
that.   Now,  of  course,  every  intern,  even  medical  students,  can 
get  into  a  vein  and  put  blood  in. 

Hughes:    It  would  seem  to  me,  though,  that  lack  of  blood  would  certainly 
hold  back  surgical  procedures  on  a  large  scale. 

Gerbode:  Oh,  it  did. 

Hughes:   You  need  massive  amounts,  don't  you? 

Gerbode:  Yes.  We  found  that  out  in  Europe  during  the  war,  as  they  did  in 
the  South  Pacific.   On  the  East  Coast  the  blood  was  taken  and 
shipped  off  to  Europe  or  Africa.   On  the  West  Coast  it  was  taken 
and  shipped  to  the  South  Pacific,  either  in  the  form  of  whole  blood 
or  in  the  form  of  plasma. 

Hughes:   Were  cross-matching  techniques  very  sophisticated  back  then? 
Gerbode:  Yes,  they  were  good  enough. 

Hughes:   Do  you  want  to  say  any  more  about  penicillin?  You  mentioned  it 
coming  in  about  1944? 


Penicillin 


Gerbode:   It  came  in  during  the  war  in  Europe.   It  was  quickly  distributed,  and 
we  set  up  a  little  special  unit  so  we  could  have  the  penicillin 
ready  to  give.   It  was  put  in  the  charge  of  one  of  the  captains  in 
the  medical  department. 

Hughes:   Was  there  plenty  of  it? 

Gerbode:  There  was  enough.   The  curious  thing  is  that  we  didn't  get  very  many 
reactions  from  it.   Since  then,  of  course,  it's  been  found  that  there 
are  quite  a  few  people  who  are  sensitive  to  it. 

[interruption] 


87 


Hughes: 
Gerbode: 

Hughes: 
Gerbode: 
Hughes: 
Gerbode: 


Hughes : 
Gerbode: 

Hughes: 
Gerbode: 


Do  you  have  any  idea  why  there  weren't  many  reactions  during  the 
war? 

No,  I  don't  know  why.   I  guess  maybe  it  was  not  as  pure  as  it  is 
now.   From  some  reason,  it  wasn't  apparent  that  there  were  many 
people  sensitive  to  it. 

Was  the  dosage  well  worked  out? 

Yes,  the  dosage  was  pretty  well  standardized. 

When  you  returned  to  the  states,  was  the  supply  still  plentiful? 

No,  it  wasn't  very  plentiful  when  we  came  back.   For  civilian  use 
it  wasn't  nearly  as  plentiful  and  generally  used  as  it  was  during 
the  war.   But  it  was  later,  of  course.   There  was  a  tremendous 
market,  and  all  the  companies  started  making  it.   That  brought 
the  price  down  and  made  it  available  very  quickly.   As  soon  as 
there  is  a  big  market  for  anything,  situations  improve. 

In  those  early  postwar  years,  how  were  decisions  made  about  which 
patients  would  receive  penicillin? 

Virtually  every  wounded  person  has  an  infected  or  contaminated 
wound,  so  you  give  penicillin  to  protect  [him]  against  massive 
infection. 

I  was  really  meaning  when  you  were  back  in  the  states  and  the  supply 
wouldn't  cover  everybody.   Then  you  had  to  make  a  decision. 


You  didn't  give  people  prophylactic  penicillin,  for  example, 
give  it  to  people  who  really  had  a  serious  infection. 


You'd 


Drugs  Regulating  Blood  Coagulation 


Hughes:    I  see.   Drugs  to  regulate  blood  coagulation. 

Gerbode:   We  were  using  massive  quantities  of  blood  in  extracorporeal 

circulation.   In  fact,  at  one  point,  our  unit  here  was  using  10  percent 
of  the  total  output  of  the  Irwin  Memorial  Blood  Bank.   We  were  the 
biggest  users  of  blood  because  of  the  heart-lung  machine.   We  were 
the  only  ones  [on  the  West  Coast]  doing  open  heart  surgery  then. 
So  we  were  very  important  customers  for  them.   I  realized  very  soon 


88 


Gerbode:   that  we  needed  to  know  more  about  blood  coagulation  and  the  use 
of  heparln  and  how  to  neutralize  heparin.   So  we  got  a  full-time 
blood  person  by  the  name  of  Herbert  Perkins  as  a  research  worker 
in  blood. 

Hughes:   He  was  a  hematologist? 

Gerbode:  An  M.D.  hematologist.  He  stayed  with  us  during  the  formative  years 
and  helped  us  a  lot  in  working  up  techniques  to  neutralize  heparin, 
which  we  gave  during  extracorporeal  circulation  to  prevent  the 
blood  from  coagulating,  and  developed  methods  of  testing  how  much 
protamine  to  give  to  neutralize  heparin.   He  began  to  be  pretty 
well  known,  so  he  was  offered  a  job  [at]  Washington  University  in 
St.  Louis.   In  any  event,  either  that  situation  or  another  one 
occurred.  Let  us  say  he  went  to  St.  Louis  and  got  an  academic 
post  and  stayed  there  for  several  years  and  found,  like  a  lot  of 
people,  that  St.  Louis  is  not  a  very  nice  place  to  live.   [laughs] 
The  weather  is  terribly  hot  in  the  summer  and  terribly  cold  in  the 
winter.   So  he  soon  realized  he'd  rather  come  back  to  the  Bay  Area. 
So  he  got  a  job  with  the  blood  bank  as  a  research  person,  and  he's 
still  there  now.  He  is  the  director  of  research  at  the  Irwin 
Memorial  Blood  Bank.   [He  is]  on  full-time  salary  there  and  is 
well  known  throughout  the  world  for  his  contributions  in  blood. 

The  problems  with  blood  and  everything  related  to  it  are  much 
more  involved  than  they  were  in  the  beginning.   [The  problems  were] 
with  platelets  and  platelet  transfusions  and  separating  platelets 
and  other  cells  from  the  blood,  and  then  later  giving  red  blood 
cells  without  plasma,  and  then  giving  plasma  without  red  cells. 
These  are  all  things  that  have  developed  with  the  use  of  blood.   All 
the  methods  of  keeping  blood  in  good  condition  for  longer  periods 
of  time  have  been  worked  out. 

Hughes:   And  it  was  the  heart-lung  machine  that — 
Gerbode:  That  was  part  of  it,  yes. 
Hughes:   — made  this  knowledge  essential. 

Gerbode:  Well,  [Perkins]  got  started  with  extracorporeal  circulation  at  our 
unit,  and  then  all  these  other  things  have  developed  since  then. 


89 


Visiting  Professor  at  St.  Bartholomew's  Hospital,  London, 
1949-1950 


Frank  Rundle,  George  Ellis  and  Emmanuel  Amoroso 


Gerbode:   In  1949  I  was  offered  a  position  as  an  associate  [in  surgery]  at 

St.  Bartholomew's  Hospital.   It  was  largely  because  of  the  experimental 
work  I  was  doing  in  a  field  which  was  opening  up.   Some  of  the 
papers  I'd  written  on  experimental  vascular  and  cardiac  surgery 
were  being  published.   I  guess  I  had  a  mini  reputation  at  that  time. 
Frank  Rundle  was  the  associate  director  of  the  professorial  unit 
at  St.  Bartholomew's.   Actually,  as  time  went  on,  I  was  offered 
the  job,  because  he  wanted  to  go  back  to  Australia. 

Hughes:   What  was  the  unit? 

Gerbode:   The  professorial  unit  is  the  main  teaching  unit,  although  they 
[also]  teach  in  other  units  there. 

Hughes:    In  surgery? 

Gerbode:   Yes.   But  they  had  a  professorial  unit  in  medicine  as  well.   Then 

the  other  London  hospitals  had  similar  ones,  where  they  were  teaching 
medical  students.   That  unit  is  the  one  that  makes  up  all  the 
schedules  for  the  medical  students  and  arranges  the  lectures  and 
does  all  the  teaching  and  research  functions. 

*# 

Gerbode:   The  ward  services  are  run  by  consultants;  they  teach,  too,  but  not 
as  much  as  the  professorial  unit. 

I  had  an  operative  list  that  I  was  given  almost  daily.   I 
operated  very  soon  after  I  got  there.   I  did  the  first  patent 
ductus  at  St.  Bartholomew's.   I  operated  upon  some  blue  children, 
too.   This  was  before  open  heart  surgery.   They  would  just  assign 
me  some  cases  on  the  operative  list  every  week.   At  that  time  the 
anesthesiologist  became  a  very  good  friend  of  mine.   His  name  was 
George  Ellis,  a  very,  very  fine  chief  of  anesthesiology,  a  bachelor 
and  a  very  interesting  man.   He  used  kind  of  old  fashioned  medicines, 
but  he  was  very  good  in  managing  an  open  chest,  usually  just  by 
inflating  a  bag  by  hand.* 


*This  sentence  was  transferred  from  the  session  recorded  on  10/23/83. 


90 


Gerbode:  Anyway,  Frank  Rundle  was  the  assistant  director  of  the  unit.   He 

was  like  an  associate  professor  in  a  medical  school.  He  had  pretty 
well  decided  he  was  going  to  leave  England  and  go  back  to 
Australia.  They  wanted  to  get  some  research  going  at  that  time. 
I  think  I  mentioned  this  before,  that  I  was  able  to  get  permission 
to  operate  on  animals  at  the  Royal  Veterinary  College  in  London 
through  Professor  [Emmanuel  Ciprian]  Amoroso,*  who  was  professor 
of  physiology.   He  was  an  extremely  kind  and  intelligent  man,  almost 
blind  from  some  sort  of  eye  disorder. 

In  England  at  that  time,  food  was  still  rationed.   Particularly 
meat  and  eggs  were  hard  to  find.   "Amo"  was  also  the  chief  physician 
for  the  London  zoo,  and  every  once  in  a  while  an  animal  would 
disappear  somehow  [laughter],  and  then  I'd  get  a  leg  of  something  or 
other,  which  might  have  been  a  goat  or  pig.   It  would  arrive  at  the 
house  and  keep  us  supplied  with  some  meat.   Also,  I  was  doing 
vascular  and  cardiovascular  and  pulmonary  research  in  the  [Royal] 
Veterinary  College  which  had  an  abundant  supply  of  animals,  dogs, 
sheep  and  goats. 

Hughes:   Because  of  this  connection  with  Amoroso. 

Gerbode:   Because  the  Royal  Veterinary  College  had  to  be  supplied  with 

animals,  so  we  had  plenty  of  animals  to  work  on.   I  did  a  lot  of 
research  there.  At  the  same  time,  there  was  a  neurosurgical  group 
doing  a  lot  of  research,  too.   Their  animals  were  always  sacrificed 
at  the  end  of  their  experiments,  so  they  quickly  found  it  was  very 
desirable  to  do  their  experiments  on  sheep  or  goats.   So  that  way 
they  had  a  good  supply  of  meat,  too.   [laughter]  The  one  who 
worked  with  me  at  the  time  was  Jerry  Taylor,  who  had  been  a  fellow 
here  with  me  in  San  Francisco. 

Incidentally,  Rundle  came  over  here  and  was  the  first  fellow 
I  had.   He  had  been  at  the  Mass  [Massachusetts]  General  Hospital 
previously  and  found  that  he  really  had  a  hard  time  getting 
laboratory  time,  and  he  couldn't  really  get  anything  going.   But  1 
gave  him  lots  of  opportunity  in  the  lab  here.   It  was  then  that  I 
got  to  know  him,  and  I  think  that's  probably  why  I  was  invited  to 
go  over  there  the  following  year.  He  came,  I  guess,  in  1947  or  '48. 

Jerry  Taylor  came  later.   Jerry  was  just  a  young  man  in  the 
department.   He  worked  with  me  in  the  dog  lab  at  the  Royal 
Veterinary  College.   He  got  a  young  girl  who  was  trying  to  be  a  vet 
to  come  help  us  as  well,  and  he  finally  married  her  and  had  some 


*Professor  Amoroso  died  10/30/82  at  the  age  of  81. 


91 


Gerbode:   children  by  her.   But  I  think  they've  subsequently  been  divorced. 
She  was  a  great  help  to  us,  because  she  loved  to  go  back  on 
weekends  and  take  care  of  the  animals.  She  just  thought  that  was 
a  great  thing  to  do,  and  she  was  very  good  at  it. 


Dog  Surgeon 


Hughes:   All  this  was  unusual  for  British  surgery  at  this  time? 

Gerbode:   Oh,  yes.   I  mentioned  before  that  most  of  the  British  surgeons 

didn't  believe  in  experimental  surgery  .   They  called  the  people 
like  me  "dog  surgeons."  Not  all  of  them,  but  some  did. 

Hughes:   How  did  they  expect  surgeons  to  learn? 

Gerbode:   They  would  just  start  doing  things  on  human  beings.   Of  course, 

they  weren't  doing  very  much.   They  were  doing  what  you  might  call 
old-fashioned  surgery,  because  they  weren't  doing  vascular  or 
cardiac  surgery,  and  they  were  just  beginning  to  do  thoracic 
surgery.   They  were  operating  on  lung  tumors  or  bronchiectasis 
or  tuberculosis;  that  was  acceptable,  and  that  was  about  it.   There 
were  a  few  people  who  recognized  that  to  get  on  in  a  new  field.,  you 
had  to  use  experimental  animals.   Otherwise  you'd  be  doing 
experiments  on  humans. 

Hughes:    Is  that  what  Rundle  recognized? 

Gerbode:   He  recognized  that  I  could  do  it.   He  saw  in  our  old  lab  [at 

Stanford  San  Francisco]  experiments  that  we  were  able  to  conduct, 
and  Amoroso  in  London  believed  in  it,  too.   That's  why  he  was 
very  anxious  to  help  me. 

Hughes:    It  sounds  as  if  you  were  very  fortunate  in  having  these  two 

connections.   You  could  have  gotten  over  there  and  found  you  had 
no  [opportunity  for  research] . 

Gerbode:   It  was.   Well,  I  wouldn't  have  gone  unless  I  had  a  pretty  good 

prospect  of  being  able  to  do  something.   The  dean  was  a  fellow  by 
the  name  of  Harris,  and  after  I'd  been  there  for  a  few  months,  he 
began  to  ask  whether  I  would  be  interested  in  staying.   He  told  me 
how  lovely  it  was  to  have  a  house  in  the  country,  and  so  forth  and 
so  on.   But. . . 

Hughes:    It  didn't  work.   [laughs] 


92 


Gerbode:   No,  I  didn't  want  to  do  that.   There  were  too  many  obstacles,  and 
there  were  too  many  built-in  restraints  in  London — even  in  the 
medical  schools  and  hospitals.  You  didn't  have  the  freedom  that 
you  have  in  this  country  in  getting  on  with  what  you  wanted  to  do. 

Hughes:   Are  you  thinking  particularly  of  the  hierarchy? 

Gerbode:  Yes,  and  the  concepts.   The  professor  of  surgery,  Sir  James 

Patterson-Ross,  had  a  laboratory  for  experimental  surgery  built 
in  the  hospital,  but  it  was  built  in  a  very  strange  way  with 
cubicles  and  a  lot  of  things  which  were  not  modern  in  concept.   It 
was  for  that  reason  that  I  went  over  to  the  veterinary  college, 
because  there  we  had  a  big  room  with  lots  of  space  and  people  to 
take  care  of  the  animals.   It  was  a  different  concept. 


Research  on  Vascular  Anastomoses  and  Respiratory  Problems 


Hughes:   Did  the  type  of  experimentation  you  were  doing  stay  pretty  much 
the  same?  Were  you  still  working  on  vascular  anastomoses? 

Gerbode:  Oh,  yes,  it  was  directly  in  front  of  doing  open  heart  surgery.   It 
was  the  leading  edge  of  getting  there,  you  might  say. 

Hughes:   And  was  that  what  you  were  consciously  working  toward? 

Gerbode:  Yes.   I  didn't  have  an  extracorporeal  machine  at  that  time.   But 
the  techniques  we  were  using  were  the  forerunners  of  what  we  were 
able  to  use  later  on  when  we  did  get  an  extracorporeal  machine. 

Hughes:   Would  you  explain  what  those  techniques  were? 

Gerbode:  We  were  doing  vascular  anastomoses  and  experiments  on  the  problems 
of  respiration  in  thoracic  surgery. 

Hughes:   There  were  several  papers  on  positive  pulmonary  pressure.  Was  that 
what  you  were  thinking  about? 

Gerbode:  Yes,  that's  what  we  were  thinking  about,  what  was  the  best  pressure 
to  use  and  how  to  control  respiration.   There  were  some  concepts 
based  on  experimental  surgery  which  I  felt  at  the  time  were  probably 
wrong.   So  T/e  devised  some  experiments  to  prove  that  they  were 
probably  wrong.   It  takes  a  while  to  do  these  things,  you  know. 


93 


Hughes:   What  were  the  wrong  concepts? 

Gerbode:   One  of  the  concepts  was  why  did  the  blood  pressure  go  down  when 
there  was  too  much  intrapulmonary  alveolar  pressure.   The  old 
concept  was  that  the  heart  was  squeezed  by  the  lungs,  and  that's 
why  the  pressure  went  down.   My  feeling  was  that  the  pressure  went 
down  mainly  because  the  alveolar  circulation  was  interfered  with 
by  too  much  intrapulmonary  pressure  at  the  capillary  level. 

Hughes:   How  do  you  get  a  feeling  like  that?  Observation? 

Gerbode:   No,  it's  just  that  you  think  about  a  concept,  and  you  think  about 

whether  it's  right  or  wrong.   If  you  think  it's  not  right,  you  have 
to  prove  that  it  isn't  right.   That's  where  experimental  work  comes 
in,  you  see.   Or  if  you  think  something  is  right,  and  everybody  else 
thinks  it  isn't  right,  then  you  have  to  show  why  it's  right. 

Hughes:   But  the  hard  part  is  getting  the  idea  to  counter  the  existing  idea. 

Gerbode:   Well,  I  suppose  that  is  hard,  but  you're  not  filled  with  some  of 

these  things  every  day.   You  think  of  one  thing,  and  then  you  have 
to  work  on  it  for  months  to  prove  it  so  or  dispose  it  so.   That's 
what  experimental  surgery  is  about. 

Anyway,  we  had  a  wonderful  year  there  in  London.   I  made  lots 
of  friends  and  have  kept  up  an  association  with  England  ever  since 
in  various  ways.   I  had  made  some  friends  among  the  English  surgeons 
during  the  war,  mainly  in  Sicily.   They  were  friends  when  I  got  to 
London,  and  we  saw  them  and  got  interested  in  their  careers,  and 
this  was  very  nice  for  us. 


Honorary  Perpetual  Student 


Gerbode:   Later  on,  because  of  having  been  at  St.  Bartholomew's,  they  made  me 
an  honorary  perpetual  student,  which  is  the  only  honorary  degree 
they  can  give  at  St.  Bartholomew's.   I  guess  when  I  was  made  an 
honorary  perpetual  student,  there  had  only  been  seventeen  before,  or 
maybe  I  was  the  seventeenth.   They  had  a  little  ceremony  and  gave 
me  three  huge  volumes  of  the  history  of  St.  Bartholomew's  Hospital, 
which  started  in  the  fifteenth  century.   They  said  at  the  time,  "We 
have  to  make  you  a  perpetual  student  because  it's  going  to  take  you 
that  long  to  read  these  three  books."  So  anyway,  that  meant  that 
I  could  wear  the  honors  tie  of  St.  Bartholomew's.   They  have  two 
different  kinds  of  ties.   They  have  one  [for]  a  regular  graduate. 


94 


Gerbode:  Then  they  have  an  honors  tie,  too,  which  is  slightly  different, 

and  it  has  a  little  bit  of  the  colors  of  Cambridge  University  built 
into  the  little  diagram  because  they  were  associated  with 
Cambridge  University  for  a  long  time. 

I'm  going  back  in  September  [1983],  because  they're  having  a 
big  banquet  at  St.  Bartholomew's.   There's  a  huge  hall  there,  the 
Great  Hall  of  St.  Bartholomew's,  with  a  high  ceiling  and  pictures 
of  all  the  old  famous  surgeons  who  have  been  there.   They  also 
have  a  list  of  people  who  have  made  contributions.   Mrs.  So-and-So 
gave  fifty  pence  to  a  certain  fund.   These  names  are  all  written 
on  the  old  wall  there.  And  the  pictures  of  the  famous  men, 
Percival  Pott  and  many  of  the  others  who  have  been  there. 

The  hospital  is  in  a  section  of  London  called  Smithfield. 
Smithfield  was  Smoothfield  at  one  time,  and  that's  where  the  farmers 
brought  in  their  produce  to  sell.   It  was  a  smooth  field.   That 
later  became  Smithfield,  and  that's  where  the  name  Smithfield  ham 
came  from.  Across  the  square  is  the  wholesale  market  for  all  the 
meat  being  distributed  in  London.   It's  a  huge  building,  and  the 
wholesalers  go  in  there  and  look  at  the  carcasses  and  pick  out  the 
ones  they  want  to  buy. 

Hughes:   An  historic  area. 

Gerbode:  The  hospital  was  started  by — I  think  the  monk's  name  was  Ruher — 

in  the  fifteenth  century.   It  was  set  up  as  a  small  dispensary  type 
of  a  hospital.   They  didn't  have  much  else  to  do  except  lance  boils 
and  operate  on  a  few  things,  take  care  of  a  few  injuries.   But  it's 
a  very  famous  hospital  in  England.  As  they  say,  you  can  always 
tell  a  Barts  man,  but  you  can't  tell  him  very  much.   [laughter] 


American  and  British  Postwar  Surgery:   A  Comparison 


Hughes:   Do  you  care  to  say  anything  more  about  the  comparison  between 
American  and  British  surgery  in  the  postwar  years? 

Gerbode:  There  have  always  been  excellent  surgeons  in  England.   I'd  say  that 
the  general  level  of  surgery  in  England  was  very  high  and  probably 
across  the  board  better  than  the  surgery  in  this  country  across  the 
board,  because  we  permitted  a  great  many  practitioners  who  had 
not  been  trained  in  surgery,  to  do  surgery.   We  still  have, 
unfortunately,  too  many  of  those  around,  whereas  in  England  major 


95 


Gerbode:   surgery  was  done  in  big  hospitals  by  men  who  were  consultants  after 
they  had  been  trained  for  some  years.   Sometimes  they  weren't  as 
modern  as  they  might  be,  but  they  were  good  anyway.   They  followed 
concepts  which  were  pretty  well  developed,  and  technically  they  did 
good  work.   They  always  had  good  assistants  and  good  people  to  take 
care  of  the  patients  afterwards. 

The  other  thing  about  the  British  hospitals  is  that  the  nurses 
have  a  great  deal  to  say  about  the  patients.   They  take  the  patients 
very  seriously,  and  if  they  find  that  a  patient  hasn't  any  place  to 
go  home,  they'll  keep  the  patient  [at  the  hospital]  until  they  feel 
it's  nice  to  send  the  patient  home.   They  don't  allow  the  surgeons 
into  the  surgical  wards  until  a  certain  time,  ten  o'clock  or 
something  like  that,  because  they  say,  "This  is  our  time  to  clean 
up  the  patients  and  get  them  set  so  that  you  can  come  around  and 
have  your  ward  rounds  at  ten  o'clock."  I  was  trained  [in  the  U.S.] 
to  arrive  at  the  hospital  at  seven  thirty  or  eight  o'clock  in  the 
morning,  and  [in  London]  I'd  get  there  every  day,  and  I  couldn't  do 
anything.   They  would  look  at  me  as  though  I  was  a  little  bit 
nutty  by  getting  there  so  early. 

Hughes:   Did  you  find  that  in  general  British  surgeons  were  open  to  new 
ideas? 

Gerbode:   I  think  after  the  war  they  were  a  little  more  receptive  to  new 

ideas.   As  I  say,  British  surgery  had  been  good  for  a  long  time.   It 
didn't  set  the  standard  for  the  training  of  surgeons  as  much  as 
the  Germans  in  the  prewar  period.   The  Germans  really  were  the  ones 
who  set  the  standards  for  the  training  of  surgeons  and  were  the 
basis  for  what  later  developed  as  the  surgical  residency  type  of 
training  in  this  country.   That  was  brought  over  by  [William  Stewart] 
Halsted  and  some  others  from  Germany.   Halsted  is  credited  with 
being  the  first  to  introduce  the  resident  surgery  training  program, 
which  is  about  five  years  of  graduated  responsibility.   This  is 
still  called  the  Halsted  method  in  this  country. 

Hughes:   Did  the  British  have  something  similar? 

Gerbode:  Not  really.  Not  quite  as  formal  as  the  Germans.  But  they  kept 
their  young  men  around  in  hospitals  for  a  long  time  before  they 
were  made  consultants. 


Hughes:   They  still  do. 


96 


Oferbode:   So  they  did  have  graduated  responsibility  in  a  way,  but  they 

didn't  quite  do  it  as  methodically  as  the  Germans.   But  then,  of 
course  there  have  been  great  [British]  surgeons.   [Joseph  Jackson] 
Lister  and  his  technique  of  preventing  wound  infection  set  the 
standard  for  the  whole  world,  and  there  were  other  men  who  did 
remarkable  things  in  surgery. 

Hughes:   How  do  you  explain  the  fact  that  in  your  field,  in  cardiovascular 
surgery,  the  British  weren't  even  trying? 

Gerbode:  No,  they  didn't  get  it  started  until  [after]  we  had  gotten  started. 
As  I  mentioned  before,  one  of  the  main  reasons,  I  think,  was  that 
there  were  a  lot  of  young  well-trained  [American]  surgeons  who  went 
into  the  war  from  universities,  from  residencies  and  from  minor 
academic  positions.  Then  when  they  came  back  from  the  war,  many 
of  them  wanted  to  get  back  into  university  life,  but  there  wasn't 
really  much  to  do.   They  weren't  given  clinical  responsibility, 
so  they  went  into  the  dog  lab.   So  you  had  all  these  bright  young 
lads  working  in  the  dog  labs  while  they  were  waiting  to  have  a 
chance  at  clinical  surgery.   They  were  teaching,  and  they  also  were 
pretty  experienced  in  managing  big-time  surgery  because  of  the  war, 
and  they  had  a  lot  of  confidence.   Furthermore,  they  could  see  what 
the  future  was  because  of  some  advances  that  I  mentioned  before, 
[which]  sort  of  opened  the  door.   Then  once  the  door  was  opened, 
inside  the  room  were  hundreds  of  people  who  needed  to  have  operations- 
children  mainly  at  that  time. 

Hughes:   The  British,  however,  would  have  had  similar  opportunities,  except 
for  the  opportunity  to  do  research. 

Gerbode:  That's  right. 

Hughes:   Probably  that  was  the  key. 

Gerbode:  That's  right.  They  didn't  have  the  laboratories  to  do  the  research. 
Furthermore,  they  didn't  encourage  people  to  do  the  research.  They 
didn't  give  them  an  opportunity.   Whereas  in  this  country,  luckily 
we  had  federal  money  given,  pumped  into  the  universities,  to  train 
young  people.   For  example,  almost  from  the  very  beginning,  as  soon 
as  I  began  to  write  some  papers  [after  World  War  II],  I  was  given 
a  training  program  by  NIH,  to  train  one  or  two  cardiac  surgeons 
who  had  already  trained  in  general  surgery.  Uncle  Sam  paid  for  it. 

Hughes:   And  the  [British]  Medical  Research  Council,  was  that  formed  much 
later? 


97 


Gerbode:   This  was  when  it  was  starting. 

Hughes:   But  they  weren't  funding  experimental  surgery? 

Gerbode:   Not  very  much — it  was  very,  very  difficult.   To  do  experimental 
surgery,  you  were  supposed  to  have  a  veterinary  license  at  that 
time.   So  they  said  if  you  are  going  to  operate  on  animals,  you're 
going  to  have  to  get  a  veterinary  license.   So  I  said,  "Okay,  I'll 
apply  for  one,"  and  I  got  it  the  day  I  left,  almost  a  year  later, 
[laughter] 


Cardiovascular  Surgery 


Hughes:   Now  that  we've  talked  so  long,  maybe  we've  covered  everything  in 
this  quote.   You  start  the  paper,  which  is  called  "Experimental 
Surgery  of  the  Heart  and  Great  Blood  Vessels"* — you're  the  first 
author;  the  second  author  is  F.F.  Rundle — with  the  following 
paragraph: 

Substantial  as  are  the  recent  advances  in  the  therapy 
of  the  congenital  defects,  it  is  not  too  much  to  say  that 
cardiovascular  surgery  is  still  in  its  infancy.   Thus 
the  chief  scourge,  coronary  artery  disease,  is  still 
beyond  surgical  grasp .   So ,  too ,  are  the  chronic  valvular 
defects.   Yet  we  are  conscious  today  that  the  field  is 
developing  rapidly.   Further  spectacular  advances  may 
well  lie  just  ahead,  for  the  surgeon  has  new  and  powerful 
weapons  at  hand,  drugs  to  regulate  the  coagulability  of 
the  blood,  penicillin,  blood  transfusions,  controlled 
respiration  during  thoracotomy,  and  methods  for  vascular 
suture  and  hemostasis. 

I  was  wondering  first  of  all  what  you  were  thinking  about  when  you 
said  cardiovascular  surgery  is  still  in  its  infancy. 

Gerbode:   We  didn't  know  exactly  how  to  close  a  hole  in  the  heart.   It  wasn't 
until  later  that  the  patient's  own  pericardium  was  used,  or 
various  cloth  materials,  the  same  as  for  vascular  grafts. 

Hughes:   Were  there  not  people  operating  for  holes  in  the  heart  before  the 
war? 


Gerbode:   No. 


*Stanford  Medical  Bulletin  6  : 247-256,  1948. 


98 


Hypothermia* 


Gerbode:   Very  soon  after  the  war,  hypothermia  came  into  being,  mainly  [due 

to]  the  early  work  by  [Wilfred  G. ]  Bigelow  in  Toronto  and  [C.  Walton] 
Lillehei  and  [John  F.]  Lewis  in  Minnesota.   [Lillehei  and  Lewis] 
were  in  Dr.  [Owen  H.]  Wangensteen' s  department  there.  They 
collectively  found  that  they  could  reduce  the  body  temperature  of 
a  patient  and  then  quickly  do  an  intracardiac  operation. 

Hughes:   How  much  time  did  they  have? 

Gerbode:  They  had  about  fifteen  or  twenty  minutes.   That  meant  in  those  days 
that  they  could  fix  a  hole  in  the  right  side  of  the  heart,  in  the 
atrium,  because  it  was  accessible,  and  they  could  relieve  pulmonary 
stenosis,  which  was  an  obstruction  of  the  outflow  trackof  the  right 
ventricle. 

This  also  led,  under  Lillehei 's  direction,  to  the  use  of 
cross-circulation  to  do  intracardiac  surgery.  He  found  out  he 
needed  more  time,  and  so  he  operated  on  children  with  the  mother 
being  the  donor.   They'd  hitch  the  mother  to  the  child  or  the  baby. 
The  mother  would  supply  the  circulation  while  the  baby  was  operated 
upon.   This  was  quite  complicated  and  led  to  a  fair  number  of 
mishaps.   But  it  did  show  that  if  you  could  use  some  kind  of  an 
extracorporeal  arrangement ,  that  you  could  open  the  heart  and 
operate  upon  it.** 

## 

Gerbcde:  Anyway,  hypothermia  came  in,  and  then  some  people  even  tried  to 
close  holes  in  the  ventricles  with  hypothermia.   But  that  didn't 
work  very  well,  because  it  takes  a  little  longer,  and  it's  more 
complicated  than  closing  a  hole  on  the  atrial  side. 

Hughes:   It's  more  complicated  anatomically,  you  mean? 

Gerbode:  Yes.  You  have  to  do  more  sewing,  and  it's  harder  to  do  it. 

Hughes:   This  is  going  back  to  something  you  said  just  a  minute  ago,  that 
the  right  atrium  is  more  accessible.   I  don't  understand  that. 


*See  the  session  recorded  on  8/16/83,  pp.  107-109,  for  further 
discussion  of  hypothermia. 

**A  discussion  of  heart-lung  machines  was  moved  to  the  session 
recorded  on  8/16/83. 


99 


Gerbode:   It's  on  the  right  side  of  the  heart,  and  either  with  a  medial  or  a 
right  thoracotomy,  it's  right  there  in  front  of  you.   You  can 
cut  into  the  atrium  and  sew  on  it  and  take  pieces  of  it  out  without 
interfering  with  the  circulation.   The  atrium  will  tolerate  that. 

Hughes:   But  wasn't  that  a  new  concept  in  itself,  that  you  could  do  these 
things  without  interfering  with  the  circulation. 

Gerbode:   Well,  it  wasn't  a  concept;  it  was  a  finding,  really. 


Vascular  Anastomoses  to  the  Heart 


Hughes:   Was  that  your  finding  when  you  were  doing  the  work  on  vascular 
anastomoses? 

Gerbode:   Yes,  it  was.   When  I  was  doing  experimental  surgery,  I  found  that 
I  could  sew  the  atrium  and  do  anastomoses  to  it.   In  fact,  I  wrote 
some  papers  on  it. 

Hughes:   Right  after  the  war. 
Gerbode:   Yes. 

Hughes:   Now,  was  that  a  first?  You  were  working  with  the  superior  vena  cava, 
as  I  recall. 

Gerbode:   Yes,  that's  right.   It  was  among  the  first,  but  I'm  sure  other 

people  were  working,  not  exactly  the  same  way  that  I  was,  but  they 
were  finding  out  they  could  cut  into  the  heart  and  sew  it  up. 

Hughes:    I  read  something  that  gave  me  the  impression  that  keeping  the  heart 
in  its  natural  position  was  very  important.   One  of  Elliott  Cutler's 
problems  apparently  was  that  he  was  displacing  the  heart  as  he 
was  operating,  and  it  was  only — 

Gerbode:   Yes,  it  was.   You  can't  do  that. 

Hughes:   — later  that  it  was  found  that  you  really  had  to  keep  the  heart — 

Gerbode:   You  had  to  keep  the  heart — if  it  was  going  to  pump — where  it 
belongs. 

Hughes:   The  reason  I  bring  this  up  now  is  that  when  you  were  doing  these 
anastomoses,  you  really  had  to  be  very  careful  about  how  you  were 
handling  [the  heart]. 


100 


Gerbode: 


You  had  to  be  very  careful.   You  couldn't  displace  the  heart  very 
much,  because  then  the  patient — the  dog — would  go  into  shock.   So 
you  had  to  do  these  things  with  the  heart  in  situ,  in  its  customary 
place. 


Hughes:   What's  the  mechanism  there? 

Gerbode:  It's  a  complicated  mechanism.  Part  of  it  has  to  do  with  the  nerve 
supply  to  the  heart.  But  I  think  also  it  means  that  the  valves  get 
distorted  when  you  move  the  heart,  and  they  don't  function  as  well. 


101 


IV  THE  DEVELOPMENT  OF  CARDIOVASCULAR  SURGERY 
[Interview  5:  August  16,  1983  ]//# 

The  1983  California  State  Bill  on  Animal  Experimentation 

Gerbode:   Even  now  there  is  a  bill  before  our  state  legislature  to  limit  the 
use  of  animals  for  experimental  purposes.   This  is  extremely 
foolish,  and  is  mainly  sponsored  by  southern  Calif ornians,  mostly 
in  Hollywood.  What  they  don't  realize  is  that  animals  are 
sacrificed  in  pounds  every  year  by  the  thousands.   In  San  Francisco 
alone  we  kill  five  thousand  dogs  a  year,  stray  dogs  that  have 
been  cast  out  by  people  who  don't  want  them.   These  animals  could 
be  used  very  beneficially  for  humanity  for  experimental  projects 
of  a  wide  variety.   The  animals  do  not  suffer.   They're  all 
anesthetized  or  very  carefully  taken  care  of.   This  work  is  always 
supervised  by  special  people  who  are  watching  constantly  about 
whether  or  not  bad  treatment  is  given  to  the  animals.  High  standards 
have  to  be  maintained  because  we  get  government  projects,  and  they 
maintain  surveillance  over  the  work. 


Oxygenators,  Hypothermia  and  Open  Heart  Surgery* 

Gerbode:   When  we  came  back  from  the  war,  most  of  us,  as  I  mentioned  before, 
didn't  have  very  much  clinical  work  to  do,  so  we  were  interested 
in  working  on  what  we  thought  was  the  frontier  of  medicine,  and 
we  turned  to  the  laboratory.   Just  with  regard  to  open  heart  surgery, 


*See  the  session  recorded  4/23/84,  pp.  349-352,  for  further 


discussion  of  these  topics. 


102 


Gerbode:   I  performed  over  three  hundred  animal  experiments  before  I  did  a 
human  open  heart  operation.   You  must  realize  in  those  times  we 
didn't  even  know  what  type  of  tube  to  pump  blood  through.   In 
England  they  were  still  using  rubber  tubes,  which  is  of  course 
very  bad.   It  wasn't  until  industry  got  into  the  picture,  realizing 
that  there  was  going  to  be  a  huge  market  in  plastics,  that  they 
became  competitive.   They  knew  that  there  was  going  to  be  quite 
a  bit  of  money  in  it,  as  there  has  been. 


John  and  Maly  Gibbon:  The  First  Heart -Lung  Machine* 


Gerbode:   The  first  heart-lung  machine  was  developed  by  Dr.  John  Gibbon  and  his 
wife  Maly.   He  started  his  work  in  Boston  when  he  was  a  young  staff 
person  before  the  war.   He  had  a  young  lady  who  had  a  pulmonary 
embolus,  and  he'd  watched  her  die  because  there  wasn't  anything 
they  could  do  to  get  that  blood  clot  out  of  her  lung.   He  said  to 
himself,  "If  I  only  had  a  machine  that  would  take  over  the  pumping 
and  oxygenating  of  the  blood,  then  I  could  have  taken  that  clot 
out  of  there."  That's  when  he  and  his  wife  Maly  [Mary  Hopkinson] 
started  working  on  a  heart-lung  machine.   Jack  has  since  died,  but 
his  wife  now  lives  in  the  Boston  area.   They  worked  together  in  the 
laboratory  for  years.   Subsequently,  when  he  was  made  professor  of 
surgery  at  Jefferson  Medical  School  in  Philadelphia,  he  continued 
his  work  there,  and  he  was  helped  financially  by  the  IBM  Corporation. 

Jack  was  the  first  one  to  use  extracorporeal  circulation  with 

a  heart-lung  machine  in  the  successful  closure  of  an  atrial-septal 

defect.   So  not  only  did  he  have  the  first  heart-lung  machine,  but 

he  was  the  first  one  to  use  it  successfully. 

Hughes:   This  was  in  the  early  '50s? 

Gerbode:  Yes.   Unfortunately,  his  machine  was  rather  complicated,  difficult 
to  run. 


*This  section  incorporates  material  recorded  on  8/10/83. 


103 


John  Kirklin  and  the  Gibbon  Heart -Lung  Machine 


Gerbode:   It  was  a  screen  type  of  oxygenator  and  was  only  used  extensively  in 
one  place  in  the  country,  and  that  was  with  Dr.  [John  W. ]  Kirklin 
at  the  Mayo  Clinic.   He  quickly  used  it,  or  a  modification  of  it, 
on  a  large  series  of  patients  at  the  Mayo.   Dr.  Gibbon  himself  did 
the  first  successful  patient  with  that  machine,  but  he  did  not 
have  the  volume  nor  the  organization  to  do  lots  of  cases,  which 
was  true  of  Dr.  Kirklin. 

Hughes:   Was  it  deliberate  that  Kirklin  was  the  only  one  that  had  access 
to  the  machine? 

Gerbode:   The  Mayo  Clinic  decided  that  it  was  very  important  to  get  into  the 
field  of  open  heart  surgery.   They  have  tremendous  resources  and  a 
big  organization,  so  they  can  go  into  anything  that  way  with  lots  of 
people  participating.   Then  the  Mayo  also  is  in  the  center  of 
the  United  States  and  is  a  place  where  they  collect  all  kinds  of 
cases.   They  made  it  advantageous  for  the  cardiac  patients  to  go 
there. 

Hughes:   Why  did  the  Mayo  decide  that  cardiovascular  surgery  was  the  thing? 

Gerbode:   They  always  like  to  get  into  whatever  is  going  to  be  important  in 
medicine  or  surgery,  and  they  are  financiallly  so  well  off  that 
they  can  do  it.  They  can  get  resources,  spend  money  on  equipment 
without  delay  or  the  problems  that  you  might  find  at  a  university. 
So  they  got  into  the  picture  very  quickly. 


The  DeWall  Bubble  Oxygenator 


Gerbode:   Working  in  Walt  Lillehei's  laboratory  was  a  fellow  by  the  name  of 
[Richard  A.]  DeWall.   DeWall  used  the  principle  of  running  oxygen 
through  blood  to  oxygenate  it.   The  oxygen  would  drive  out  the 
carbon  dioxide,  so  he  had  blood  that  was  fully  saturated  with  oxygen 
without  much  C02-   He  made  what  is  called  the  DeWall  bubble 
oxygenator ,  which  is  the  prototype  for  the  most  widely  used  type 
of  oxygenator  everywhere  now.   It's  not  the  best,  but  it's  practical 
and  it's  cheap  and  easy  to  run,  and  this  has  big  advantages.   For 
a  short  case  it's  adequate,  but  for  a  long  case  it  isn't. 

Hughes:   Why  is  that? 


104 


Gerbode:   Exposing  blood  directly  to  oxygen  and  bubbling  it  through  a  device 
such  as  they  use  requires  some  method  of  getting  the  bubbles  out, 
which  they  do  with  chemicals  or  collecting  tubes.   But  they  can't 
get  them  all  out.   There  are  still  microbubbles  in  the  blood,  and 
the  body  doesn't  like  those.   The  body  will  tolerate  a  certain 
number  of  them  for  a  while,  but  if  the  operation  goes  on  for  three 
or  four  hours,  then  so  many  of  them  accumulate  that  organs  fail, 
and  the  brain  is  damaged,  too. 

Hughes:   So  the  membrane  oxygenator  would  be  used  for  lengthy  operations? 

Gerbode:  People  realized  that  the  bubble  oxygenator  was  useful  and  practical 
up  to  a  certain  point,  but  the  membrane  oxygenator  was  a  more 
ideal  [device] ,  because  there  was  not  a  direct  interface  between 
the  oxygen  and  the  blood.   The  oxygen  had  to  diffuse  through  a 
membrane  to  get  to  the  blood,  and  the  CC>2  had  to  go  out  through 
that  membrane,  which  is  better.   In  other  words,  the  blood  wasn't 
exposed  to  air  or  the  atmosphere.   One  of  the  first  to  work  on  this 
principle  was  George  [H.A. ]  Clowes,  [Jr.]. 

[Interruption] 


George  Clowes  and  the  Membrane  Oxygenator 


Gerbode:   George  Clowes  developed  a  membrane  type  of  oxygenator  which  was 
very  complicated  to  run,  but  it  actually  demonstrated  that  one 
could  use  a  device  of  this  kind,  simplified  if  possible,  for  open 
heart  surgery,  and  that  it  would  probably  be  better  than  the  other 
types. 


The  Bramson  Membrane  Oxygenator 


Gerbode:  This  led  a  lot  of  laboratories,  including  our  own,  to  get  started 
in  developing  a  membrane  oxygenator.   I  am  rather  sad  to  say  that 
we  have  spent  approximately  twenty  years  on  this  project.   We 
finally  went  through  several  versions,  one  of  which  I  used  in  about 
two  hundred  fifty  cases,  which  was  a  prototype  for  one  which  will 
hopefully  be  made  commercially  very  soon  by  the  Harvey  Company. 


105 


Gerbode:   The  problem  with  all  these  devices  is  that  things  have  to  be 

simple  to  use  and  be  economical.   So  it's  been  a  problem  to  make 
it  so  simple  that  any  profusionist  could  use  it  and  then  have  it 
disposable  and  not  have  to  be  resterilized  or  cleaned,  because 
that  increases  labor  and  raises  the  cost  a  good  deal. 

There  have  been  three  or  four  membrane  oxygenators  developed 
since  Clowes  introduced  it.   They  are  sold  commercially  by  a 
number  of  firms  now.   We  think  the  one  we've  been  working  on  is 
going  to  be  better,  but  we'll  have  to  wait  and  see  whether  it  will 
be.   The  tests  seem  to  indicate  that  it  will  be.   It  takes  an 
awful  lot  of  money  to  develop  something  like  this.   I  can't  tell 
you  how  much  money  we've  spent  on  this  one  project,  but  it's  probably 
a  hundred  and  fifty  or  two  hundred  thousand  dollars.   The  company 
that  is  working  on  it  has  already  spent  a  half  a  million  dollars 
to  bring  it  up  to  commercial  availability. 

Hughes:   Was  that  a  competitive  matter? 

Gerbode:  Oh,  yes,  it's  competition  against  several  others  which  are  on  the 
market  already.  People,  logically,  will  pick  the  one  which  works 
the  best  and  is  cheapest. 

Hughes:   What  are  the  advantages  of  yours? 

Gerbode:   One  advantage  is  that  it  has  a  built-in  heat  exchanger,  so  you  can 
cool  and  warm  the  blood  easily,  which  means  that-  you  can  use 
hypothermia,  reduced  body  temperature,  quite  simply  with  the 
device.   Some  of  the  other  devices  require  another  instrument  to 
raise  or  lower  the  body  temperature.   The  other  things  is  that  it 
is  extremely  atraumatic.   Also  it  preserves  the  platelets  better 
than  some  of  the  others,  and  platelets  are  very  important  in  blood 
coagulation. 

Hughes:    I  assume  it's  a  synthetic  material  from  which  it's  made. 

Gerbode:   It's  mainly  design,  the  internal  method  of  oxygenating  the  blood. 
The  blood  goes  through  a  very  thin  layer  while  it's  exposed  to 
the  oxygen  through  a  membrane.   The  way  that  turbulence  is  caused 
inside,  in  the  machine,  either  damages  the  blood  or  doesn't.   It 
either  oxygenates  it  perfectly  or  it  doesn't.   And  we've  done  so 
many  experiments  on  how  to  run  the  blood  through  the  machine  to 
make  it  atraumatic  and  efficient  that  we  think  that  maybe  we're 
better  than  others  in  that  respect. 

Hughes:   Were  you  influenced  at  all  in  the  theoretical  stage  by  anatomy, 
by  how  nature  does  it? 


106 


Gerbode:  Oh,  yes!   You  see,  this  oxygenator  is  like  the  lung.   It's  like  the 
blood  going  through  capillaries  in  the  lung.   And  there  the  red 
cells  and  white  cells  tumble  around  as  they  go  through,  and  the 
blood  is  turbulent,  so  that  all  the  cells  will  be  exposed  to 
oxygen.   You  do  the  same  thing  with  the  membrane  oxygenator. 

Hughes:   One  of  the  real  problems  in  the  early  days  was  hemolysis,  was  it 
not? 

Gerbode:  Hemolysis  is  another  one.   Our  oxygenator  has  a  very  low  hemolysis 

rate.   The  bubble  oxygenator  has  a  very  high  incidence  of  hemolysis, 
and  the  longer  you  use  it,  the  more  hemolysis  there  is.  These 
are  some  of  the  factors. 

It's  also  been  shown  that  a  membrane  oxygenator  is  really 
well  tested  by  using  it  on  a  baby,  because  the  baby  is  a  very 
fragile  little  human  being,  and  if  you  use  coarse  equipment  like  a 
bubble  oxygenator  on  a  baby,  unless  you  operate  quickly,  the  baby 
will  get  sick  or  maybe  die.   But  it's  been  shown  by  several  centers 
in  the  world  that  you  can  put  a  baby  on  a  membrane  oxygenator  much 
more  safely  to  do  various  things.  We're  operating  on  small 
children  and  babies  much  more  frequently  than  when  we  started. 

Hughes:   Because  you  trust  the  machine? 

Gerbode:  And  because  it's  better  to  correct  many  of  these  things  early  in 
infancy,  before  secondary  effects  from  the  lesion  they  have  begin 
to  affect  the  anatomy  of  the  child. 

Hughes:   How  early? 

Gerbode:   Some  open  heart  procedures  are  done  in  the  first  year,  maybe  six 
to  twelve  months.   And  there  are  other  ones — like  a  patent  ductus 
or  a  Blalock  procedure — which  can  be  done  very  soon  after  birth 
with  a  relatively  low  mortality  rate. 

Hughes:   Even  with  surgical  expertise,  that  would  have  been  impossible  before 
you  had  an  adequate  heart-lung  machine. 

Gerbode:  Yes.   But  a  lot  of  these  things,  like  doing  a  ductus  or  Blalock 
procedure  early,  [are]  possible  because  of  better  anesthesia, 
specialized  anesthesia,  and  understanding  the  physiology  of  a 
big  operation  in  a  baby,  what  not  to  do.  Fluid  balance  and  such 
things  as  how  much  pressure  you  use  in  the  anesthetic  machine,  and 
the  delicacy  of  the  administration  of  the  anesthetic.   Some 
anesthesiologists  just  don't  like  to  touch  babies,  because  they're 
too  apprehensive. 


107 


Hughes:   That,  then,  is  not  a  standard  part  of  a  residency  in  anesthesia? 

Gerbode:   Oh,  I  think  most  residents  have  at  least  to  be  there  when  babies 

are  done,  but  I  don't  think  a  first-year  or  second-year  resident  in 
anesthesia  would  be  given  a  baby  to  do  until  they  were  pretty 
sure  he  knew  what  he  was  about. 

Hughes:    I  hope  not.   You  mentioned  in  the  case  of  the  early  British  machines 
that  the  rubber  tubes  were  causing  damage. 

Gerbode:   Yes.   It's  even  true  now.   Russia  and  China  don't  have  a  very  good 
plastic  industry.   China  has  virtually  none.   So  they  take  the 
tubes  which  they've  used  to  conduct  blood  and  clean  them  with 
brushes  and  chemicals  in  a  special  room.   Then  they're  all  hung  up 
like  spaghetti  on  the  wall  to  dry  out.   Then  they're  sterilized. 
But  you  cannot  really  clean  a  tube  perfectly  that  way.   There  are 
always  tiny  bits  of  foreign  material  still  left  in  there,  and  the 
body  senses  that  very  quickly.   So  when  you  use  equipment  like 
that,  there  are  fevers  and  sometimes  infections.   Where  the  tube 
is  put  into  the  vein,  in  an  arm,  it  will  thrombose  quite  easily  or 
get  infected. 

Hughes:    So  that's  yet  another  advantage  of  your  machine;  the  very  fact  that 
you're  seeking  to  make  it  disposable  isn't  just  a  money  matter, 
it's  also  a  safety  precaution. 

Gerbode:   Well,  you  know,  it  is  a  money  matter  in  the  end,  because  you  know 
the  one  who  can  produce  the  best  disposable  machine  is  the  one 
that's  going  to  be  sold. 


Hypothermia  (Continued) 


Hughes:   You  mentioned  hypothermia  and  talked  a  little  bit  about  it  last 
time,  but  I'm  curious  about  the  fact  that  hypothermia  and  the 
heart-lung  machine  were  really  going  in  tandem,  and  yet  it  took  a 
number  of  years,  maybe  ten  years,  before  the  two  techniques  were 
put  together.   Why  was  that? 

Gerbode:   The  main  reason  that  hypothermia  took  hold  in  the  beginning  and 

was  used  by  people  like  Henry  Swan,  John  Lewis,  and  Walt  Lillehei, 
among  others,  was  that  they  didn't  trust  the  heart-lung  machine. 
Maybe  this  was  justified,  because  the  early  heart-lung  machines 
were  traumatic  and  not  terribly  good.   So  they  would  choose 


108 


Gerbode:  operations  which  they  could  do  under  reduced  body  temperature, 
which  would  last  only,  say,  ten  minutes.   They  did  them  quickly 
and  got  in  and  out  in  a  hurry.  When  they  tried  to  use  hypothermia 
to  close  ventricular  septal  defects,  it  would  take  twenty  minutes 
or  thirty  minutes,  and  then  they  got  into  bad  trouble. 

Hughes:   That  would  be  impossible,  wouldn't  it? 

Gerbode:   It's  possible,  but  it's  very,  very  risky.   You  never  know  for  sure 
what  will  be  found.   The  advantage  of  the  heart-lung  machine  is 
that  if  you  find  something  that  you  didn't  quite  expect,  or  if  you 
find  the  repair  is  more  difficult  than  a  standard  repair,  there  is 
time  to  make  the  adjustment.  Although  the  longer  you  stay  on  the 
machine,  the  harder  it  is  on  the  patient,  you  can  keep  a  good  machine 
going  for  four  or  five  or  six  hours — not  a  bubble  oxygenator ,  but  a 
membrane — and  still  the  patient  won't  be  bothered  too  much  by  it. 

Hughes:   Did  you  yourself  ever  use  hypothermia? 

Gerbode:  Yes,  I've  used  hypothermia,  but  I  avoided  the  broad  use  of  it  for 
open  heart  surgery,  because  I  didn't  want  to  waste  time  on  it.  I 
thought  if  I  got  started  up  that  path,  it  would  take  me  away  from 
[developing]  a  heart-lung  machine  that  worked. 

Hughes:   So  you  were  convinced  from  the  start  that  the  heart-lung  machine 
was  possible. 

Gerbode:  Oh,  yes,  possible  and  the  best.   So  instead  of  worrying  about  how 
much  to  use  hypothermia,  I  spent  all  the  time  in  the  laboratory 
trying  to  develop  a  machine.   We  have  used  hypothermia  with  the 
heart-lung  machine,  and  most  people  do,  because  it  reduces  the 
necessity  for  full  take-over  of  the  circulation.   In  other  words, 
you  can  take  over  maybe  half  or  two-thirds  of  the  circulation  and 
use  modest  hypothermia  to  protect  the  body  for  the  reduced  amount 
of  circulation  that  is  necessary  [at  lower  body  temperatures]. 

Hughes:   Were  you  also  involved  in  research  to  determine  the  proper  level  of 
hypothermia? 

Gerbode:  Yes,  we  did  quite  a  bit  of  that.  We  did  a  whole  bunch  of  patients 
using  hypothermia  for  brief  operations,  not  requiring  more  than, 
say,  ten  or  fifteen  minutes.   But  I  never  liked  it  very  much.   It 
was  too  scary.   So  now,  of  course,  hypothermia  of  the  heart  itself — 
in  other  words,  using  the  heart-lung  machine  and  using  cold  plus 
chemicals  to  stop  the  heart  during  open  heart  surgery  or  valve 
replacement  or  valve  repair — is  the  standard  procedure.   Everybody 


109 


Gerbode:   uses  it  now.   They  inject  cold  solutions  into  the  coronaries 

through  the  root  of  the  aorta  to  stop  the  heart,  make  it  quiet, 
and  then  you  have  a  bloodless  field  which  isn't  moving,  so  you  can 
operate  faster  and  it's  better. 

Hughes:    Is  that  the  way  you  initially  used  hypothermia? 

Gerbode:   No.   We  didn't  use  that  until  after  it  was  introduced  in  Germany, 
mainly,  and  after  a  few  other  places  in  this  country  started 
using  it.   We  were  not  very  early  in  the  development  of  hypothermia 
of  the  heart. 

Hughes:   I've  seen  pictures  of  bathtubs  in  the  operating  theater. 

Gerbode:   Yes.   [laughter]   That  was  total  body  hypothermia,  mainly  for 

children.   Some  people  even  now  use  total  circulatory  arrest  for 
complicated  repair  of  children's  hearts.   The  Japanese  and  some 
surgeons  in  New  Zealand  have  the  child  in  a  tub  of  ice-cold  water 
and  reduced  the  body  temperature  to  twenty  or  twenty-one  degrees,  and 
then  operated  quickly,  and  then  raised  the  body  temperature  again 
ofter  the  repair. 

Hughes:    Is  that  [done  with]  children  particularly  because  they  can  bounce 
back  better? 

Gerbode:   They  bounce  back.   They  can  respond  to  this  better  than  an  adult 
can,  and  of  course  they're  smaller,  so  you  can  [better]  control 
the  [temperature]  of  the  mass  of  the  child. 

Hughes:    I  understand  that  was  quite  a  problem:   the  temperature  would  drop 
after  you  thought  you  had  reached  the  proper  level. 

Gerbode:  Yes,  it  goes  down  even  more,  and  it's  slow  to  recover,  too.  We 
find,  for  example,  when  we  use  hypothermia  with  a  heart-lung 
machine  and  we  think  that  the  body  temperature  is  thirty-seven  in 
the  operating  room,  by  the  time  the  patient  is  in  the  recovery 
room,  very  often  it's  lower.   So  we  always  quickly  start  putting 
blankets  on  to  keep  the  patient  warm  so  that  won't  happen. 


Teamwork 


Hughes:   Perhaps  this  is  the  time  to  talk  about  teamwork.   I  think  it  under 
lies  a  lot  of  your  research,  but  in  one  paper  you  particularly 
stress  the  importance  of  teamwork  in  cardiovascular  surgery.   I  was 
wondering  if  you  could  say  a  little  more  about  this,  because  I  think, 
again,  this  was  a  postwar  realization,  was  it  not? 


110 


Gerbode:  Although  the  surgeon  always  gets  credit  or  abuse  for  whatever 

happens  during  a  heart  operation,  actually  how  well  he  does  really 
depends  on  his  team.   The  best  results  are  found  in  places  where 
there  is  good  teamwork:  good  assistants,  good  nurses,  excellent 
postoperative  care,  and  the  use  of  other  ancillary  personnel  who 
understand  the  problem. 

One  of  the  first  things  I  found  out  when  we  were  experimenting 
and  trying  to  develop  the  whole  field  was  that  we  were  constantly 
trying  to  invent  things,  which  was  really  a  form  of  biomedical 
engineering — electronic  devices,  gadgets  of  different  kinds.   We 
were  constantly  going  off  to  instrument  makers  and  other  people 
trying  to  get  them  to  understand  what  we  wanted,  and  to  get  them 
to  make  it.  Well,  the  work  was  frequently  crude  and,  not  being 
engineers,  we  really  didn't  do  it  very  well. 


M.L.  Bramson  and  the  Membrane  Oxygenator 


Gerbode:   So  one  day  I  met  a  fellow  by  the  name  of  M[ogens]  L.  Bramson,  who 
was  working  at  that  time  as  a  consultant  with  Mr.  Ed  Heller.   Ed 
was  terminating  [his]  work,  because  [he]  felt  that  Mr.  Bramson  had 
done  everything  he  could  for  them — his  research  involved  byproducts 
of  wood.   I  met  Mr.  Bramson  in  Paris  at  a  cocktail  party,  and  I 
said,  "What  are  you  doing?"  He  said,  "I'm  an  engineer,  but  I'm 
terminating  with  Mr.  Heller."  I  said,  "Would  you  be  interested  in 
biomedical  engineering?"  He  said,  "Of  course  I  would.   I'd  be  very 
interested." 

So  I  brought  him  into  our  unit  and  got  him  the  first  established 
investigator ship  for  a  non-M.D.  in  the  American  Heart  Association. 
Everybody  said  you  can't  have  the  American  Heart  Association  paying 
for  an  established  investigator  unless  he's  an  M.D.   I  said,  "Why 
not?"  They  finally  gave  him  an  investigator ship.   The  money  wasn't 
very  great.  We  had  to  supplement  it  a  good  deal,  but  still  the 
principle  was  there.   Now,  of  course,  everywhere  in  the  world  there 
are  all  sorts  of  engineers  and  people  working  with  doctors. 

Hughes:   This  was  now  maybe  early  '50s,  would  you  say? 

Gerbode:  Yes,  early  "50s.  We  called  him  "Bram."  That's  his  statue  over 
there.   Bram  very  quickly  mastered  all  the  mathematics  and 
physiological  principles  of  dealing  with  blood  and  circulation  and, 
being  a  very  brilliant  man,  he  quickly  saw  the  problems  and  began 


Above : 

On  a  visit  of  the  Surgeon 
General  to  Presbyterian 
Medical  Center's  Cardiopulmonary 
Unit,  1966.   Dr.  John  Osborn, 
far  right;  Dr.  Frank  Gerbode, 
third  from  right. 


Left: 

Mogens  L.  "Bram"  Bramson, 
IMS  engineer  who  designed  the 
Bramson  membrane  oxygenator, 
and  Dr.  John  Osborn,  Director 
of  the  Presbyterian 
Cardiopulmonary  Unit,  test  out 
the  promising  life-saving  device. 


Ill 


Gerbode:   to  try  to  solve  them.   Well,  making  a  membrane  oxygenator  in  the 

early  1950s  was  not  anything  you  did  in  a  few  months.   We  realized 
that  it  was  going  to  take  a  long  time,  and  we  had  [a  backlog  of] 
patients  waiting  for  operation.   So  he  and  I  and  Dr.  Osborn  made 
another  type  of  disk  oxygenator  as  a  temporary  expedient,  waiting 
for  the  years  to  roll  by  before  the  membrane  would  be  ready.   We 
used  that  disk  oxygenator  for  maybe  three  hundred  cases  or  more. 
It  was  very  good,  atraumatic,  and  we  could  control  body  temperature 
very  well  with  it. 

In  any  event,  Bram  worked  shoulder  to  shoulder  with  us  all 
the  way  through.   Finally,  it  got  to  the  point  of  having  our  first 
prototype  membrane  oxygenator ,  which  was  used  in  prolonged 
profusions,  mainly  with  the  help  of  Dr.  [Donald]  Hill,  who  took 
over  the  project  of  applying  it  to  traumatic  lungs  and  viral 
pneumonia  patients  who  were  really  in  desperate  shape  because  of 
their  reduced  pulmonary  capacity.   Bram  participated  in  all  the 
early  experiments  using  that  prototype  membrane  oxygenator.   We 
found  that  we  could  keep  a  dog  alive  for  days  with  it,  which  was 
something  you  couldn't  do  with  a  bubble  oxygenator.   And  we  finally 
applied  it  to  human  beings  in  a  project  sponsored  by  the  National 
Institutes  of  Health.   This  was  a  cooperative  project  with  a  number 
of  other  centers  in  the  world.   It  was  a  controlled  experiment  of 
alternating  patients  to  see  whether  or  not  using  a  device  like  that 
in  patients  who  were  dying  from  severe  pulmonary  insufficiency 
would  work. 

We  found  out  [we  could] 


Gerbode:   ...quite  safely  keep  a  patient  alive  for  days.   The  longest  one  was 
twenty-three  days.   We  kept  a  patient  on  almost  complete  control 
of  the  lungs  with  a  machine  for  twenty-three  days.   That's  a  record, 
I  think,  and  it  showed  that  a  membrane  oxygenator  could  be  a  very 
useful  tool  in  various  types  of  pulmonary  insufficiency. 


Industrial  Development  of  the  Membrane  Oxygenator* 


Gerbode:  We  finally  got  our  membrane  oxygenator  up  to  the  point  where  it  had 
to  be  further  developed  by  industry,  because  you  can  show  the  value 
of  a  certain  concept  or  a  certain  group  of  instruments  to  do  a 


*This  section  was  moved  from  the  session  recorded  on  9/27/83. 


112 


Gerbode:   certain  job  biologically,  but  if  you're  going  to  apply  that  to 

thousands  of  people,  then  you  have  to  get  into  a  different  category 
of  investigation.   So  we  turned  over  our  patents  to  our  membrane 
oxygenator  to  [the  Harvey]  Company.  They  meanwhile  spent  about  a 
million  dollars  developing  it  to  the  point  where  it  could  be  produced 
on  a  large  scale  for  daily  use  and  made  safe. 

Hughes:   Does  that  company  have  large  research  labs? 

Gerbode:  Yes. 

Hughes:   How  do  they  handle  the  patient  trial  aspect  of  it? 

Gerbode:  They  farm  it  out.   For  example,  this  membrane  oxygenator  was  tried 
in  a  university  hospital  with  a  certain  number  of  patients,  very 
carefully  observed,  very  carefully  documented,  and  proven  to  be 
quite  effective. 

Hughes:   The  company  made  the  choice? 

Gerbode:  The  company  made  the  choice  where  to  do  it.  They  had  to  get  somebody 
to  agree  to  do  it.   They  were  required  to  obtain  FDA*  approval. 
Usually  good  places  will  try  things  out  if  they  look  safe.   These 
new  things  are  all  presented  to  patients  clearly,  so  nobody  is 
victimized  by  any  experiment. 

Hughes:   And  the  company  pays  the  hospital  for  doing  the  testing? 

Gerbode:   Sometimes,  or  they  give  them  all  the  equipment  and  everything  to 
do  it  with. 

Hughes:   Does  the  government  regulate  this  in  some  way? 

Gerbode:  Oh  yes.   You  have  to  submit  the  protocols.  You  have  to  go  through 
a  certain  testing  protocol  with  animals  first.   That's  evaluated  by 
the  FDA  and  by  peer  committees,  and  if  that  is  satisfactory,  then 
the  patient  testing  is  approved,  and  they  will  designate  a  certain 
number  of  patients  to  be  done,  and  that  certain  observations  have 
to  be  made  on  these  patients. 

Hughes:   A  panel  makes  those  decisions? 


*Federal  Drug  Administration 


113 


Gerbode:   Yes.   A  peer  group  outlines  what  has  to  be  done.   So  with  our 

membrane  oxygenator,  we've  gone  through  all  this  already,  and  now 

the  company  is  just  getting  it  down  to  the  point  where  they  can 

produce  the  device  with  virtually  no  possibility  of  any  failure 
in  any  part  of  it. 

Hughes:   Remarkable.   To  graduate  from  one  stage  to  the  next,  i.e.,  from  the 
animal  experimentation  to  the  human,  is  solely  based  on  survival 
rate? 

Gerbode:   No.   It's  a  matter  of  making  certain  observations,  and  these 
observations  are  designated  by  a  peer  group  of  experts.   For 
example,  [if]  you're  using  something  in  which  blood  is  being  used, 
you  can't  have  a  certain  amount  of  hemolysis,  you  can't  lose 
platelets,  you  can't  lose  red  cells.   A  lot  of  criteria  are  set 
up.   The  FDA  has  done  this,  acting  on  advice  from  experts. 

Hughes:   Yet  when  it  comes  to  pure  surgical  procedures,  without  the  use  of 
artificial  devices  of  any  kind,  there's  no  such  regulation,  is 
there? 

Gerbode:   If  you're  using  a  new  surgical  procedure  which  has  been  more  or 
less  established,  you  have  to  go  to  the  patient  and  say,  this  is 
still  somewhat  experimental.   You  require  the  patient  to  sign  a 
document  stating  that  he  understands,  because  otherwise  he  might 
sue  you. 

Hughes:   But  that's  a  different  sort  of  regulation. 
Gerbode:   Yes. 


The  Disk  Oxygenator 


Hughes:   How  did  the  disk  oxygenator  fit  into  the  picture? 

Gerbode:   The  disk  oxygenator  was  a  temporary  thing  which  we  were  using  because 
we  couldn't  get  the  membrane  oxygenator  working  properly.   We  finally 
did,  but  it  was  only  a  prototype.   The  one  we  are  hoping  to  get  on 
the  market  soon  is  an  outgrowth  of  that  prototype,  but  is  a  much 
better  device  and  very  easy  to  use,  and  it's  disposable. 

Hughes:   Do  you  remember  the  date  when  the  disk  oxygenator  was  first  used? 

Gerbode:   It  was  late  '50s,  early  '60s. 

Hughes:   Was  that  always  just  a  one-model  machine? 


114 


Gerbode: 


Hughes: 
Gerbode: 


Hughes: 
Gerbode: 
Hughes : 
Gerbode: 

Hughes : 
Gerbode: 


We  had  twelve  of  those  devices,  and  they  were  rotated.   They  were 
taken  over  to  Cutter  Laboratories  [in  Berkeley]  in  Mr.  Bramson's 
car  and  completely  cleaned  and  sterilized  and  brought  back  ready  to 
use.   It  was  a  terribly  cumbersome,  difficult  process.   But  we 
found  that  unless  we  removed  every  tiny  bit  of  blood  or  protein  from 
the  inside  of  that  device,  patients  would  get  the  same  thing  they 
get  when  you  put  blood  through  a  rubber  tube.   They  get  fevers  and 
various  other  things  which  are  very  disagreeable. 

Why  did  Cutter  have  the  sterilizing  set-up? 

We'd  been  working  with  Cutter  for  quite  a  while  on  devices  of 
various  kinds.   In  fact,  we  worked  with  them  until  they  moved  to 
Santa  Ana  a  few  years  ago.   We  were  always  having  some  kind  of  a 
project.   In  fact,  they  worked  with  us  in  the  later  development  of 
the  now  being  finalized  membrane  oxygenator.   They  shared  in  our 
patents,  too,  because  there  was  a  lot  of  work  in  using  membranes 
and  how  to  put  them  together  and  how  to  test  them,  which  Cutter 
helped  us  with. 

They  had  a  whole  research  staff? 

They  had  a  whole  research  room  set  aside  for  our  work. 

Did  they  ever  sell  an  oxygenator? 

No,  they  never  got  to  the  point  of  commercial  development  of  the 
membrane  oxygenator.   They  sold  some  of  the  disk  oxygenators. 

When  did  the  membrane  oxygenator  come  in? 

I  suppose  we  tried  it  on  these  prolonged  pulmonary  profusion  patients 
about  ten  years  ago.   Cutter,  of  course,  shared  in  some  of  our 
developments.   When  the  whole  project  was  taken  over  for  commercial 
development  by  the  Harvey  Company,  the  Harvey  Company  paid  Cutter 
a  certain  amount  for  their  patents ,  so  they  could  use  them  in  the 
final  development. 

This  is  very  exciting  work.   To  find  that  you  could  put  a 
patient  on  this  device  for  days  meant  that  if  you  put  them  on  for 
hours,  that  they'd  be  better  off  than  they  would  have  been  if 
you'd  had  them  on  a  bubble  oxygenator  or  another  kind  of  device. 
In  fact  that  they  would  stay  alive  after  a  long  time  [on  the 
membrane  oxygenator]  meant  that  they'd  be  not  so  sick  for  a  shorter 
time  [on  it].   That's  why  people  still  want  to  have  that  device. 


115 


Hughes: 


Gerbode: 


Would  you  care  to  say  something  about  the  acceptance  of  these 
machines  by  your  colleagues? 

The  acceptance  is  a  bit  difficult  until  you  can  make  it  easy  [to 
use],  because  the  men  who  run  the  profusion  devices,  run  the 
heart-lung  machines,  are  usually  technicians,  and  they  don't  really 
like  anything  that's  very  complicated.   They  like  to  have  it  easy 
to  put  together,  easy  to  run,  easy  to  get  rid  of.   We've  always 
been  lucky  here,  because  we've  always  had  a  physician  supervising 
the  work.   Dr.  John  Osborn  has  followed  all  this  work  and  has  been 
responsible  for  many  of  the  developments  from  the  very  beginning. 
So  we  were  always  ahead  of  the  game  by  having  an  expert  physiologist, 
you  might  say,  standing  side  by  side  with  the  project  that  whole 
time. 


Pump  Technicians 


Hughes:   What  about  the  training  of  the  technicians? 

Gerbode:   We  were  lucky  in  training  our  own.   We  got  a  technician  from  the 
East  Coast  who  was  very  good  with  bubble  oxygenators  (which  we 
finally  had  to  say  we  were  going  to  use  as  a  temporary  expedient, 
and  we  still  use  them).  Angelo  latridis  is  a  very  good  profusionist. 
He  trained  at  least,  five  technicians  with  us,  who  are  equally  good, 
and  one  who  was  especially  good  at  doing  research.   See,  we  still 
do  a  lot  of  research  on  animals  in  various  ways.   We're  constantly 
testing  devices  and  doing  things  on  animals  to  find  out  what's  best. 

Hughes:    Is  there  now  a  formal  setup  for  training  technicians? 

Gerbode:   No.   I  don't  know  exactly  where  there  is  right  now.   I  know  that 
they've  been  wanting  to  have  a  formal  training  period.   They  have 
their  own  society,  and  they  meet  once  or  twice  every  year,  and  they 
have  a  publication.   But  I'm  not  sure  what  the  requirements  are 
for  training.   The  ones  we  have  are  really  good.   Actually,  Mr. 
latridis  and  Dr.  Osborn  very  seldom  had  to  be  there  early  in  the 
morning  to  get  things  going.   [The  other  technicians]  got  it  all 
going  very  well.   Then  Mr.  latridis  and  Dr.  Osborn  came  in  and  kept 
an  eye  on  it,  and  were  there  if  anything  happened. 

Hughes :   Do  technicians  have  some  engineering  know-how? 

Gerbode:   Oh,  yes,  they  know  how  to  run  it  very  well,  and  if  anything  goes 
wrong,  they  know  what  to  do. 


116 


Hughes:   Do  they  also  know  the  physiological  aspects? 

Gerbode:   Not  too  much,  but  they  know  when  to  take  [blood]  samples  and  how  to 

run  the  tests  during  an  operation.  The  interpretation  is  really 

done  either  by  the  anesthesiologist  or  the  physician,  if  he's 
there,  or  the  surgeon. 

Hughes:   Could  you  say  something  more  about  the  tests,  how  often  they're 
done? 

Gerbode:  They  do  oxygen  saturations.   They  measure  the  temperature  of  the 

blood.   They  measure  the  CC>2  of  the  blood.   Then  as  they're  coming 
off  profusion,  they  measure  the  blood  coagulability  and  adjust  the 
dosage  of  protamine  to  be  sure  the  heparin  in  the  blood  is 
neutralized  properly. 

Hughes:   Is  there  now  an  established  protocol  for  all  of  this? 

Gerbode:  Yes.   As  I  mentioned  to  you  before,  there  were  so  many  problems 

about  blood  and  using  machines  that  we  got  Dr.  Herbert  Perkins  to 
work  with  us.   He  now  is  the  chief  research  hematologist  for  the 
blood  bank  in  San  Francisco  and  has  made  a  lot  of  contributions 
in  blood  banking.  We  published  some  good  papers  in  the  early  days 
on  various  things  about  blood  and  profusion.   Since  then,  of  course, 
the  literauure  is  full  of  all  sorts  of  papers. 

Hughes:   It's  very  interesting  to  an  historian  to  follow  something  like  this 
through,  because  with  time,  the  normal  development  is  for  more  and 
more  formalization.   Institutions  grow  up.   You  mentioned  the 
technicians  now  have  a  society.   Is  there  something  similar  for 
physicians? 

Gerbode:   The  hematologists  have  their  own  society. 
Hughes:   But  I  mean  even  more  subdivided  than  that. 


The  American  Society  for  Artificial  Organs 


Gerbode:   There  is  an  artificial  organ  society,  and  they  discuss  heart-lung 

machines,  artificial  hearts,  various  devices  to  augment  the  circulation 
in  shock  and  other  situations.   They  meet  a  couple  of  times  a  year 
and  have  a  publication,  too. 

Hughes:   That's  for  physicians? 


117 


Gerbode:   Yes,  physicians  and  profusionists.   But  it's  really  mainly  run 

by  physicians  or  research  people.   It's  called  the  American  Society 
for  Artificial  Organs. 

Hughes:   You  mentioned  that  some  people  preferred  hypothermia  and  distrusted 
the  heart-lung  machine.   I  wonder  if  that  interfered  with  grants 
in  the  beginning.   Were  people  in  NIH,  for  example,  skeptical  of 
the  success  of  the  heart-lung  machine? 


Pumps 


Gerbode:   No.   Actually,  I  was  on  the  surgical  study  section  at  the  time  when 
this  all  exploded,  you  might  say.   There  were  many  applications 
for  devices  which  when  put  together  would  become  a  heart-lung 
machine.   In  fact,  one  of  the  pumps  they  were  using  at  that  time 
was  the  so-called  sigma  motor  pump.   It  was  used  by  people  in  the 
field  because  it  was  the  first  pump  available  that  would  pump 
something  through  a  tube.   It  was  a  pump  which  was  used  by  the  milk 
industries  to  move  milk  along  in  a  tube  from  where  they  took  it 
out  of  a  cow  to  a  tank  where  it  was  stored. 

On  the  surgical  studies  section  where  all  these  applications 

were  coming  through  for  research  funding,  they  all  [required] 

a  sigma  motor  pump,  and  a  lot  of  them  were  put  together  so  they 

could  get  a  sigma  motor  pump.   I  suggested  one  time  during  one  of 

the  meetings  that  we  buy  a  whole  bunch  of  them  and  give  everybody 
a  sigma  motor  pump  so  they  wouldn't  have  to  apply  for  it  formally 
through  a  research  protocol.  [laughter] 

But  then  other  pumps  came  in  which  were  much  better.   There 
was  another  type  of  roller  pump  which  is  called  a  DeBakey  pump.   It 
was  actually  devised  by  some  French  people.   Dr.  DeBakey  brought 
it  over  from  Europe  many  years  ago  to  push  blood  along  in  a  tube 
for  transfusions.   Then  they  made  larger  and  improved  versions  of  it. 
Roller  pumps  just  roll  the  blood  through  a  tube.   They've  become 
less  traumatic  and  much  better  as  time  has  gone  on. 

Hughes:   What  was  happening  in  Europe  in  regard  to  the  heart-lung  machine? 


118 


Dennis  Melrose's  Heart -Lung  Machine 


Gerbode:  There  wasn't  really  much  on  the  continent.  Dr.  Melrose  in  London, 
who  came  to  work  with  us,  had  a  machine  which  he  devised  and 
actually  produced  commercially.   In  fact,  I  brought  one  over  with 
him  to  try  out  in  our  laboratory.   I  tried  it  on  some  patients.  We 
found  it  was  too  traumatic  to  use  routinely. 

Hughes:   That  was  the  design? 

Gerbode:  Yes.  There  was  too  much  turbulence  in  it.   It  was  like  a  washing 
machine.  He  introduced  it  into  some  centers  in  Europe,  mainly 
Eastern  Europe,  and  they  used  it  there  for  a  while,  until  better 
devices  came  along.   I  never  really  did  any  more  than  try  it 
experimentally  and  in  a  few  clinical  cases,  because  our  tests 
showed  that  it  was  producing  a  lot  of  hemolysis  and  was  hard  on  red 
cells.   It  was  too  traumatic. 

Hughes:   Was  that  holding  back  British  open  heart  surgery? 

Gerbode:  Not  only  that.  As  soon  as  the  bubble  oxygenator  became  available 

commercially,  they  started  using  it  over  there,  and  then  their  heart 
surgery  program  went  ahead. 

Hughes:   From  what  you're  saying,  it  doesn't  sound  to  me  as  though  there  was 

much  resistance  to  the  very  idea  of  using  extracorporeal  circulation. 

Gerbode:   There  wasn't .  You  see,  it's  the  fear  of  the  unknown  again.  A 

lot  of  them  went  into  hypothermia,  using  total  body  hypothermia  to  do 
quick  cases,  while  they  were  becoming  more  confident  in  a  machine 
of  some  kind.   And  as  soon  as  a  machine  of  some  kind  was  available, 
they  began  to  use  it. 

Hughes:   That's  quite  a  step. 

Gerbode:  Oh,  yes,  it  was  a  big  step.   It's  particularly  a  big  step  if  nothing 
is  known,  and  you  have  to  make  that  step  yourself,  and  that's  where 
we  were,  you  see.  As  I've  said  to  you,  we  didn't  even  know  what 
kind  of  tube  to  pump  blood  through. 

Hughes:   I  would  think  it  would  be  absolutely  as  great  a  step  as  the  idea 
that  the  heart  is  touchable.   For  the  first  time  in  history,  we 
were  allowing  a  mechanical  device  to  take  over  this  extremely  vital 
function. 


119 


Gerbode:   Yes,  that's  right. 

Hughes:    So  it's  more  than  just  a  technical  barrier.   It's  a  whole  conceptual 
barrier. 

Gerbode:   It  was.   That's  true  of  the  pump  aspect  of  it.   The  pump  was 
relatively  easy,  but  the  pulmonary  part  of  it,  to  get  the  gas 
exchange  in  the  blood,  was  the  more  difficult  part.   That's  why 
all  these  different  types  of  oxygenators  were  developed,  to  find 
which  was  the  most  satisfactory. 


Patient  Response 


Hughes:   What  about  the  patients'  responses? 

Gerbode:   The  early  patients  frequently  had  fevers  postoperatively,  and  some 
of  them  didn't  wake  up  as  quickly  as  we  wanted  them  to.   There  were 
minor  complications  quite  often  in  the  early  days.   But  we  gradually 
sorted  out  the  reasons  for  everything  by  constantly  testing  and 
watching.   Every  time,  in  the  early  days,  you  did-an  open  heart 
case,  you  kept  track  of  everything,  and  if  a  little  thing  went  wrong, 
you  corrected  it  that  day.   Nothing  was  left  over .   Even  if  you  had 
to  go  back  at  night  and  fix  something.   You  did  it  that  day. 

Hughes:    So  you  mean  you  would  not  do  another  operation  until — 

Gerbode:   Until  that  was  corrected. 

Hughes:   Was  that  common  procedure  everywhere,  do  you  think? 

Gerbode:  I  think  mostly  it  was  pretty  common.  I  don't  think  anyone  would 
go  on  with  a  complication  that  was  repeating  itself,  but  I  guess 
some  people  would. 

Hughes:    I'm  wondering  about  the  degree  of  patients'  [concern  about]  going 
onto  a  machine  to  sustain  their  life. 

Gerbode:   You'd  have  to  explain  to  the  mothers  or  the  fathers  or  the  patient 

what  it  was  all  about.   In  a  child  with  a  hole  in  the  heart  that  was 
making  the  child  very  sick  and  almost  dying  a  number  of  times,  you'd 
have  to  say,  "Well,  now,  there's  only  one  way  that  we  can  try  to 
stop  chis,  and  that  is  to  try  to  close  that  hole.   And  in  order  to 
close  the  hole,  you  have  to  use  a  machine."  Then  you'd  tell  them 
what  the  machine  was  about,  and  you'd  tell  them  what  the  risks  were, 


120 


Gerbode:   and  what  experience  there  had  been.   Then  they'd  almost  invariably 
would  say,  "We'd  much  rather  take  a  chance  on  doing  it  than  to  have 
the  child  die.1.1 

Now,  the  early  mortality  rates  were  quite  a  bit  higher  than 
they  are  now.   For  most  procedures  they  might  [have  been]  10  or  12 
or  15  percent  on  a  sick  child.   Now  they  are  3  or  4  percent  because 
of  all  the  improvements,  not  only  in  the  machinery,  but  in  the 
management  of  the  patients.   On  the  other  hand,  those  other  patients 
would  have  died  from  natural  causes. 


Patient  Selection 


Hughes:   Were  you  selecting  very  sick  children  in  the  early  days? 

Gerbode:  Actually,  when  we  first  started  using  open  heart  surgery  with  a 

machine,  I  didn't.   I  did  just  the  opposite.   I  picked  the  ones  I 
was  quite  sure  I  could  fix  quite  quickly  and  safely. 

Hughes:   So  you  had  great  confidence  in  the  machine  by  then? 

Gerbode:  Well,  I  had  confidence,  but  I  wanted  to  be  sure  the  team  and  every 
body  could  manage  their  assigned  duties,  so  I  didn't  get  into 
something  where  I'd  have  to  make  a  big  decision  anatomically  or 
physiologically  about  a  correction.   So  I  picked  holes  and 
obstructions  and  things  that  I  knew  that  I  could  usually  repair  in 
fifteen  or  twenty  minutes,  something  like  that,  and  where  I  knew 
what  the  anatomy  was  going  to  look  like.   This  was  a  very  good 
thing  to  do,  because  it  gave  cardiologists  and  others  confidence  in 
the  machine.   If  I'd  taken  the  very  sick  patients,  I  would  have 
lost  a  lot  of  them,  and  they  would  have  lost  confidence  in  the 
whole  venture. 


Cardiologists 


Gerbode:  Cardiologists  are  just  as  afraid  of  their  own  reputation  as  they  are 
of  the  patients'  survival,  and  they  don't  like  to  get  involved  in 
something  where  the  result  isn't  going  to  be  good. 

Hughes:   Did  you  have  problems  at  any  time  with  cardiologists? 


121 


Gerbode:   Oh,  you  always  have  problems  with  cardiologists.   [laughter] 

One  of  my  best  friends,  who  is  a  very,  very  famous  cardiologist 
in  New  England — he's  one  of  the  great  cardiologists,  a  pioneer  with 
a  tremendous  reputation — said  to  me,  "Frank,  a  cardiologist  without 
a  surgeon  is  a  nothing."   [laughs]   And  it's  true,  because 
cardiology  as  practiced  today  really  got  started  because  surgeons 
could  repair  these  things  in  the  heart.   That  brought  out  all  the 
diagnostic  techniques — cardiac  catheterization,  angiocardiography, 
use  of  sound  to  diagnoses  abnormalities  in  the  heart.   It  all  started 
because  the  surgeons  could  do  something  about  it.   Many  cardiologists 
forget  this.   They  get  to  the  point  where  they  think  they  can  order 
an  operation  and  even  order  the  type  of  repair  as  they  would  order 
a  meal  in  a  restaurant.   This  is  very  irritating  to  surgeons.   Some 
surgeons  will  take  it  because  they  don't  want  to  offend  the 
cardiologists. 

Hughes:   Because  of  this  resistance,  did  you  have  times  have  trouble  getting 
patients? 

Gerbode:   Right  after  the  war,  when  we  were  doing  closed  mitral  valvotomies — 
that  is,  we  were  fracturing  tight  mitral  valves — there  was  a  lot  of 
resistance  among  the  full-time  faculty  in  the  medical  school.   They 
wanted  to  treat  the  patients  with  digitalis  and  diuretics  forever. 
Patients  started  coming  in  when  they  found  out  that  one  could  correct 
mitral  stenosis  with  a  rather  simple  operation.   If  they  ended  up 
in  the  cardiology  ward,  they'd  stay  there  for  days  and  days  while 
everybody  scratched  their  heads  and  decided  how  many  pills  to  give 
them  and  how  sick  they  were.   It  was  only  very  rarely  that  they  would 
turn  one  of  these  patients  over  to  the  surgeon.   So  when  I  found  that 
a  referring  physician  wanted  to  have  a  patient  come  into  the  hospital, 
I'd  get  him  to  bring  the  patient  in  on  the  surgical  ward  [rather 
than  on  the  medical  ward].   And  then  I'd  invite  the  cardiologist  who 
was  most  surgically  minded  to  see  the  patient  and  bypass  all  the  rest 
of  them. 

Hughes:   How  long  did  this  go  on? 

Gerbode:   It  went  on  for  a  couple  of  years.   We  obviously  had  to  prove  ourselves 
to  them.   But  when  they  found  that  the  mortality  rate  was  very,  very 
low  and  the  results  were  good,  they  got  more  confidence  in  the 
procedure.   They  were  always  very  quick  to  point  out  the  complications. 
They  were  afraid  of  the  unknown,  afraid  of  their  reputatiors.   Fear 
has  a  lot  to  do  with  it.* 

Hughes:   Was  some  of  the  resistance  due  to  the  knowledge  of  the  really  rather 
discouraging  prewar  record  of  operations  for  mitral  stenosis? 


*These  two  sentences  were  moved  from  session  1,  7/20/83. 


122 


Mitral  Valvotomy 


Gerbode:  Yes.  The  ones  that  really  put  mitral  valvotomy  on  the  map  were 
[Charles  P.]  Bailey  in  Philadelphia  and  Dwight  Harken  in  Boston. 
At  every  surgical  meeting  they  were  there  talking,  and  fighting, 
too,  claiming  priority,  saying  that  we  did  more,  we  did  it  first, 
or  something.   But  actually,  they  talked  so  much  that  people  began 
to  realize  there  was  something  to  it.  They  did  hundreds  of  patients 
in  Boston  and  Philadelphia  before  very  many  patients  were  done  in 
the  West.   We  did  early  operations;  as  soon  as  mitral  valvotomy 
became  a  feasible  procedure,  we  did  it. 

One  of  the  first  patients  I  did,  right  after  the  war,  was  a 
paratrooper  who'd  been  in  the  army.  He  was  an  air  force  paratrooper, 
and  he  had  a  severe  mitral  stenosis,  had  gone  through  all  the 
testing  to  get  into  the  service.  He  went  through  the  whole  war, 
and  then  at  the  end  of  the  war,  he  was  in  severe  heart  failure, 
with  a  calcified  mitral  valve. 

Hughes:   They'd  missed  it  all?  Good  heavens.  The  history  of  operations  for 
mitral  stenosis  is  interesting.   There  was  a  moratorium  between 
Cutler's  last  operation,  which  was  in  1928,  and  1945  when  Bailey 
did  his  first  human  operation.  Actually,  there  were  people  in 
between  who  were  doing  operations. 

Gerbode:  Yes.  There  was  [Sir  Henry  S.]  Souttar  in  England. 
Hughes:   He,  of  course,  was  much  earlier. 
Gerbode:  Much  earlier.  He  was  the  first,  I  think. 

Hughes:   And  then  there  was  somebody  by  the  name  of  [Horace]  Smithy.   He  died 
very  soon  himself. 

Gerbode:  I'm  not  quite  sure  about  him. 

Hughes:  And  Murray — 

Gerbode:  Arthur  Murray,  yes. 

Hughes:  — who  did  some  successful  operations,  I  believe. 

Gerbode:  Yes,  he  did. 

Hughes:  But  with  a  rather  bizarre  technique. 


123 


Gerbode: 

Hughes : 
Gerbode: 
Hughes : 
Gerbode: 
Hughes : 
Gerbode: 


Hughes : 


Gerbode: 


Hughes: 
Gerbode: 


He  was  looked  upon  as  being  kind  of  a  wild  man  because  he  was  doing 
this,  too,  you  know.   He  has  a  son  with  the  same  name  who's  a 
surgeon. 

[laughs]   Do  you  know  any  of  these  people? 

Oh,  sure. 

I  know  you  know  Harken — 

Oh,  sure.   I  knew  Elliott  [Cutler]  quite  well. 

Is  this  the  place  to  say  a  little  bit  about  these  men? 

Starting  with  Bailey,  I'd  say  that  he  was  so  successful  in 
Philadephia  that  it  really  went  to  his  head.   He  proposed  all  kinds 
of  operations  which  were  very  often  radical.  As  we  would  say,  he 
would  try  the  operation  on  the  human,  then  prove  it  on  the  animal, 
[laughter]  He  did  an  awful  lot  of  straight  operations  on  humans 
before  it  was  established  that  the  procedures  were  feasible,  because 
there  were  a  tremendous  backlog  of  people  with  congenital  and 
acquired  heart  disease  that  needed  doing.   So  he  had  lots  of 
material,  and  he  ran  kind  of  a  factory  there  at  Hahnemann  Hospital 
in  Philadelphia. 

In  those  days,  the  decision  to  operate  was  solely  that  of  the 
surgeon? 

Yes,  or  he  had  very  compatible  cardiologists.   In  that  particular- 
place,  there  wasn't  really  much  wasted  time  on  ward  rounds  and 
decision  making.   If  it  looked  as  though  there  was  something  that 
could  be  done,  they'd  just  do  it. 

Dwight  Harken  in  Boston  was  quite  a  bit  more  careful.   He  used 
his  cardiologists  and  the  other  people  at  Harvard  in  determining 
the  feasibility  of  operations.   But  he  did  an  awful  lot  of  cases, 
too.   There  wasn't  anybody  really  to  stop  it.   It  was  like  sinking 
a  hole  in  the  ground  and  getting  a  gusher.   There  was  oil  there  and 
it  was  coming  out  like  crazy,  then  you  tried  to  capture  as  much  of 
it  as  you  could. 

In  general,  were  they  operating  on  very  sick  patients? 

The  first  ones  we  got  were  quite  sick,  too.   There  the  problem  was 
really  one  of  not  getting  patients  from  the  cardiologists  unless 
they  were  pretty  sick,  class  3  and  class  4  heart  failure  very  often. 
So  the  mortality  rate  was  high. 


124 


Hughes:  When  was  that  class  system  set  up? 

Gerbode:  New  York  Heart  Association. 

Hughes:  Do  you  remember  when? 

Gerbode:  No,  I  don't,  but  it  was  maybe  twenty  years  ago. 

Hughes:  Why  New  York? 

Gerbode:   I  don't  know  why.   They  just  decided  they  ought  to  classify  heart 
failure  so  people  would  know  what  they  were  talking  about. 

Hughes:   And  that  was  immediately  accepted? 
Gerbode:  Yes,  it's  accepted  pretty  much  everywhere. 

Hughes:   Would  there  be  a  stigma  against  a  surgeon  who  operated  on  a  class 
1  or  a  class  2  when  the  procedure  was  still  [experiental]? 

Gerbode:  Not  really.   [Frederick]  Glover,  who  was  working  with  Bailey  at  that 
time,  said,  "I  think  we  ought  to  operate  on  these  people  before  they 
have  very  many  symptons,  so  they  won't  get  symptoms."   [laughter] 
Of  course,  he  knew  if  he  was  operating  on  them  very  early,  he  would 
practically  never  lose  one. 

Hughes:   There's  always  a  tension  there,  I  should  think.   If  you  are 

convinced  that  a  procedure  really  is  going  to  be  very  hedpful  when 
it's  in  the  early  stages,  I  would  think  there  would  be  the  temptation 
to  take  less  sick  cases,  knowing  that  your  chances  of  success  are 
greater  and  consequently  the  procedure  is  more  likely  to  be  accepted. 

Gerbode:   I  told  you  when  we  started  open  heart  surgery  and  had  a  heart-lung 
machine,  I  picked  the  cases  of  very  low  risk.   But  when  it  came  to 
things  like  mitral  stenosis,  you  couldn't  get  the  patients  with 
very  few  symptoms,  because  the  cardiologists  wouldn't  give  them  up. 
They'd  only  give  the  ones  to  you  that  were  in  constant  heart  failure 
regardless  of  how  many  pills  they  took. 

Hughes:   Nowadays  it's  very  ritualized,  is  it  not? 
Gerbode:   It  is  ritualized  and  standardized. 


Gerbode:  We  now  have  methods  of  visualizing  the  chambers  of  the  heart,  testing 
the  lungs,  and  being  able  to  determine  very  accurately  how  badly 
the  lungs  are  affected  by  the  heart  and  getting  numbers  to  determine 


125 


Gerbode:   how  bad  it  is.   It's  pretty  well  standardized.   There  are  differences, 
however.   One  big  clinic  in  the  Midwest — I  won't  say  which  one — 
for  many  years  would  not  use  cardiac  catheterization  or  exotic 
testing  for  routine  cases.   They  felt  so  confident  of  their  ability 
to  make  a  clinical  diagnosis,  they  would  take  an  xray,  an  EKG,  and 
make  a  clinical  diagnosis,  and  let  the  surgeon  find  out  during  the 
operation  how  bad  things  were.   If  you're  good  enough,  you  can  do 
that ,  and  it ' s  a  lot  cheaper . 

In  fact,  my  own  fe«ling  is  we  do  too  many  tests  on  these  patients. 
Whenever  a  new  test  comes  along,  there's  a  tendency  not  to  subtract 
another  test  for  the  new  one,  but  to  add  it  onto  the  list,  which 
means  that  there ' s  another  five  hundred  dollars  or  whatever  in 
expenses.   So  now  a  patient  comes  in,  has  a  physical  examination, 
a  chest  film,  electrocardiogram,  an  echocardiogram,  a  cardiac 
catheterization,  and  pretty  soon  he'll  have  several  other  very 
expensive  things  done  to  him.   Then  they'll  add  it  all  up,  and  it'll 
come  out  exactly  the  same  as  their  clinical  diagnosis  was  in  the 
beginning.   But  you  have  to  keep  all  these  people  busy,  you  know. 

Hughes:    Is  there  now  a  system  derived  from  the  granting  organization  itself 
that  ensures  that  an  institution  follows  these  guidelines? 


The  Crippled  Children's  Services 


Gerbode:   No,  not  really.   The  only  control  [was]  that  the  Crippled  Children's 
Services  in  the  late  '40s  and  early  '50s  decided  that  it  would  set 
certain  minimum  requirements  for  heart  surgery,  and  these  requirements 
had  to  be  met  before  it  would  approve  payment  for  patients.   We 
helped  establish  the  first  criteria. 

Hughes:   Can  you  tell  me  what  they  were? 

Gerbode:   You  had  to  have  a  cardiac  catheterization  laboratory.   You  had  to 

have  done  a  certain  number  of  cases  with  a  very  low  mortality  rate. 
You  had  to  be  able  to  do  good  angiocardiography,  with  good  equipment, 
and  you  had  to  have  a  pediatric  service  which  could  take  care  of  the 
ordinary  illnesses  associated  with  children.   Initially  you  had  to 
have  the  use  of  an  experimental  laboratory.   This  was  very  difficult 
for  some  people.   For  example,  the  ones  in  Oakland  who  wanted  to  do 
open  heart  surgery  were  held  up  for  a  while  because  they  had  no 
experimental  laboratories  over  there.   But  the  Gripped  Children's 
Services  realized  that  an  institution  to  be  very  good  would  have  to 


126 


Gerbode:   be  doing  some  experimental  work,  trying  things  on  animals  before 
they  tried  them  on  human  beings,  which  is  a  very  mature  attitude. 
If  some  of  those  southern  California  congressmen  [who  oppose 
research  with  animals]  knew  more  about  what  they're  talking  about, 
they'd  believe  this,  too. 

Hughes:   Who  was  responsible  for  this  enlightened  attitude  in  the  Crippled 
Children's  Services? 

Gerbode:   I  won't  take  credit  for  the  whole  thing,  but  I  was  pretty  close  to 

them.   But  they  were  wise  enough,  when  you  talked  to  them  and  showed 
them  what  it  was  all  about,  told  them  what  you  believed  in.   Then 
they  could  look  around  and  see  that  nobody  was  trying  anything  in 
the  laboratory  experimentally,  and  nobody  had  very  much  experience 
yet.   [Crippled  Children's  Services  was]  not  going  to  approve  them 
until  they  somehow  got  some  experience  and  knew  what  they  were  doing. 

Hughes:   What  about  money? 

Gerbode:   I'll  tell  you  about  cardiac  catheterization,  which  is  another  story. 
You  see,  the  Crippled  Children's  Services  had  never  really  paid  for 
heart  operations;  they  were  paying  for  children  with  cleft  palates, 
harelip,  various  congenital  malformations  of  the  bones,  like  club 
feet  and  dislocated  hips,  spina  bifida,  and  that  sort  of  thing. 
But  when  heart  surgery  came  along,  they  suddenly  realized  that  if 
they  were  going  to  approve  heart  surgery  on  the  state  Crippled 
Children's  Services,  it  was  going  to  be  a  big  change  in  the  amount 
of  money  they  were  going  to  have  to  spend.  So  they  looked  at  it  very 
carefully.  And  then  it  became  apparent  that  cardiac  catheterization 
was  going  to  be  a  very  important  part  of  a  service  to  take  care  of 
children  with  congenital  heart  disease.   They'd  never  paid  for  that 
either.   So  I  took  a  trip  over  to  their  headquarters  in  Berkeley  and 
sat  down  with  [the  director  and  assistant  director]  and  told  them 
that  I  thought  that  cardiac  catheterization  was  going  to  be  very 
necessary  and  that  they  were  going  to  eventually  have  to  pay  for  it, 
like  they  had  to  pay  for  an  xray. 

So  they  sent  their  man  over,  and  he  came  and  looked  at  our 
unit.  We  had  another  meeting,  and  I  took  him  out  to  lunch.   Finally 
they  sent  me  a  letter  saying  that  they'd  pay  two  hundred  and  fifty 
dollars  for  a  professional  fee  for  cardiac  catheterization.   This 
was  a  fairly  good  amount  of  money,  since  we  weren't  getting  anything 
for  the  procedure  before.   They  also  agreed  that  they  would  pay  two 
hundred  fifty  dollars  for  an  operation  if  it  was  necessary.* 


*These  two  sentences  were  moved  from  a  similar  discussion  in  session 
4,  8/10/83,  the  rest  of  which  was  eliminated. 


127 


Hughes: 
Gerbode: 

Hughes: 
Gerbode: 
Hughes: 
Gerbode: 


How  was  Crippled  Children's  Services  raising  this  money? 
have  been  considerable. 


It  must 


They  got  more  of  an  allocation.   The  next  year  around,  they  just 
said  we  are  going  to  have  to  take  care  of  this  many  more  children, 
and  so  they  allocated  more  money. 

From  the  state? 

From  the  state,  and  some  federal. 

Was  that  the  major  source  of  your  income? 

Most  children  with  congenital  heart  disease  come  from  families  with 
not  very  much  income.   The  families  who  had  enough  income  so  that 
they  wouldn't  be  eligible  for  Crippled  Children's  Services  had 
enough  money  to  pay  for  their  [treatment]  because  it  wasn't  very 
expensive  then.   A  lot  of  them  had  comprehensive  insurance.   The 
insurance  companies  found  out  that  if  they  had  a  family  policy,  it 
had  to  cover  the  child,  too.   This  was  quite  a  discovery  on  their 
part.   They  began  to  pay  the  same  fee  as  the  Crippled  Children's 
fee  then. 


Funding  for  Cardiovascular  Research 


Hughes: 


Gerbode: 


Hughes: 

Gerbode: 

Hughes: 


What  about  the  research  side  of  it? 
from? 


Where  was  that  money  coming 


All  the  research  money  came  out  of  Heart  Association  grants, 
private  contributions,  or  NIH. 

One  of  our  first  contributions  was  not  from  any  of  these;  it 
was  from  the  Life  Insurance  Medical  Research  Fund.   [It]  must  still 
exist,  although  we've  never  applied  for  it  since  the  early  days, 
but  once  we  got  twelve  thousand  dollars  from  them.   I  remember  our 
professor,  Holman,  couldn't  believe  that  anyone  would  give  us  twelve 
thousand  dollars  to  do  research. 

How  did  that  come  about? 

He  applied,  and  then  that  came  right  back,  and  he  was  bowled  over. 

How  did  the  life  insurance  people  learn  so  quickly  that  this  was  a 
field  that  they  should  support? 


128 


Gerbode:  They  were  smart.  All  their  premiums  were  based  on  life  expectancies 
and  if  we  could  prolong  the  life  expectancy  or  prevent  certain 
illnesses  or  get  people  out  of  the  hospital  quicker,  that  was  money 
in  their  pockets.  When  penicillin  was  discovered,  they  made  millions 
of  dollars  because  people  were  being  cured  of  pneumonia  and  various 
infections,  and  this  wasn't  in  their  actuarial  calculations  yet.   It 
took  a  number  of  years  for  that  to  catch  up.   But  meanwhile,  they 
made  plenty  of  money. 

Hughes:   Were  they  foreseeing  enough  to  realize  that  they  should  support 
this  field  before  the  demands  on  insurance  policies  came  in? 

Gerbode:  No,  I  don't  think  so.   These  things  are  always  very  sluggish  and 
slow  to  develop.   I  don't  think  they  had  enough  vision  to  look 
forward  to  that. 


Mitral  Stenosis:  Operative  Procedures 


Hughes:   Do  you  have  the  energy  for  a  couple  of  more  questions  about  mitral 
stenosis? 

Gerbode:   Sure. 

Hughes:   You  stated  in  your  paper  published  in  1951,  and  I'm  quoting,  "The 
operative  treatment  of  mitral  stenosis  resulting  from  rheumatic 
fever  has  been  one  of  the  most  challenging  problems  in  cardiac 
surgery."  Could  you  enlarge  upon  that? 

Gerbode:   If  a  surgeon  saw  a  patient  with  mitral  stenosis,  with  pulmonary 

edema,  a  very  reduced  capacity  to  work  or  walk,  and  peripheral  edema, 
and  then  he  saw  the  patient  die  and  he  saw  the  lesions,  saw  the  valve, 
and  saw  that  it  was  tightly  held  together  so  the  blood  couldn't  get 
through,  he  could  realize  that  if  he  could  open  that  valve,  then 
the  patient  would  be  benefited  enormously.   So  then  various  ways 
were  tried  to  do  this.  Actually,  Souttar  tried  by  putting  his 
fingers  through  the  valve,  and  later  on  Harken  and  Bailey  did  the 
same.  We  developed  an  instrument  to  crack  the  valve  by  passing  it 
through  the  apex  of  the  ventricle,  transventricular  valvotomy  we 
called  it. 

Actually,  to  answer  your  question,  if  you  see  an  autopsy  of  a 
congenital  heart  with  a  hole  in  it,  the  surgeon  says,  "How  can  I 
close  that  hole?  What  do  I  need  to  close  that  hole?"  And  that's 
where  it  all  starts,  you  see.  We  actually  made  holes  in  the  heart 


129 


Gerbode:   in  experimental  animals,  before  we  had  a  [heart-lung]  machine,  to 
study  the  physiology  and  to  see  what  could  be  done.   I  tried  to 
pass  various  kinds  of  experimental  devices  into  the  heart  with  the 
heart  beating — buttons  and  things  like  that  to  close  those  holes. 
But  I  never  had  very  much  hope  that  it  would  work.   But  we  were 
stimulated  by  the  fact  that  if  we  could  figure  out  a  way  of  doing 
[the  operation] ,  that  there  were  lots  of  people  who  needed  to  have 
it  done. 


Communication  Among  Surgeons* 


Hughes: 
Gerbode: 

Hughes: 
Gerbode: 


Hughes : 
Gerbode: 


Hughes: 
Gerbode; 


Now,  when  you  were  working  on  these  very  innovative  procedures,  were 
you  following  the  literature  very  closely? 


Oh,  very  closely, 
to  every  meeting. 


We  were  not  only  following  the  literature;  we  went 


Is  that  generally  the  way  you  kept  up? 

I  think  there  were  a  group  of  people  in  the  country  who  were  working 
hard  in  the  laboratory  and  trying  to  get  [cardiovascular  surgery] 
put  forward.   They  would  appear  at  various  meetings  in  the  country, 
and  sometimes  abroad,  two  or  three  times  a  year.   My  travel  budget 
for  those  years  was  very  big,  and  I  was  away  from  home  a  lot,  as 
were  these  others,  too. 

Meetings  occurred  frequently  enough  to  keep  you  abreast? 

There  were  at  least  two  or  three  very  important  meetings  a  year. 
But  then  also,  even  in  those  days,  we  had  a  kind  of  a  communication 
network,  where  you  met  people  in  the  same  position  you  were  in  and 
knew  them  by  their  first  names  and  liked  them,  and  they  liked  you, 
and  so  you'd  call  them  up  quite  often  and  discuss  things  on  the 
telephone.   Or  if  they  did  something  that  was  very  important,  they'd 
call  you  and  tell  you  about  it,  knowing  that  you'd  always  give  them 
credit  if  it  was  something  original. 

So  because  of  that  system,  people  were  very  free? 

Not  all  of  them,  but  most  of  them  were.   The  good  ones  were.   And  it 
was  important  to  always  remember  if  you  did  something  that  was  an 
idea  that  somebody  else  had  had  and  gave  to  you,  that  you'd  give  them 
credit  for  it.   That's  still  mostly  true. 


*See  the  session  recorded  on  6/13/84,  pp.  415-416,  for  further 
discussion  of  communication  among  surgeons. 


130 


Mitral  Stenosis:  Operative  Procedures  (Continued) 


Hughes:   Could  you  talk  a  little  bit  more  about  the  procedure  itself? 

You  mentioned  transventricular  valvotomy,  but  I  believe  you  also 
used  the  finger  fracture  technique. 

Gerbode:  Yes.   We  had  little  thimbles,  for  example.   Some  people  found  that 
if  they  put  a  thimble  on  their  finger,  that  it  would  increase  the 
diameter  of  the  finger  and  make  the  fracture  more  complete.  Also,  , 
a  thimble  is  hard,  so  you  could  fracture  a  valve  and  separate  it 
better  if  you  had  something  hard  to  do  it  with.   I  used  thimbles 
and  various  other  things.   Some  people  actually  put  knives  in  and 
cut  the  valve,  but  this  proved  to  be  a  very  dangerous  thing  to  do, 
because  frequently  they  cut  it  in  the  wrong  place  and  made  the  valve 
incompetent.   That  wasn't  very  good. 

Hughes:   That  was  Cutler's  problem,  was  it  not? 

Gerbode:   Yes,  he  thought  you'd  have  to  cut  it.   But  actually,  it  was  shown 

by  Souttar  (although  they  forgot  about  that)  that  you  could  fracture 
it.  We  spent  a  lot  of  time  trying  to  open  that  valve  at  least  two 
finger  breadths  in  diameter.   We  wanted  to  get  it  open  to  the  end 
of  the  commissures  so  the  valve  would  be  mobile,  so  it  wouldn't  get 
stuck  together  so  easily.   If  the  corners  were  out  quite  far  enough, 
then  it  would  open  and  shut  more  completely.   If  it  was  still  tied 
in  the  corner,  then  it  wouldn't  open  completely,  and  there  was  a 
chance  that  it  would  fuse  again. 

The  other  big  problem,  of  course,  was  how  to  cope  with  clots 
in  the  heart.   There  were  various  techniques  devised  to  get  rid  of 
a  clot  that  you  found  unexpectedly  in  part  of  the  heart.   There  were 
methods  of  flushing  the  heart  out,  letting  the  blood  gush  out  of 
the  atrium  to  carry  the  clot  with  it. 

Hughes:   Was  this  a  result  of  the  procedure? 

Gerbode:  No.  About  half  the  patients  with  mitral  stenosis  sometime  or 

other  get  clots  in  the  heart,  and  these  clots  go  to  the  brain  and 
various  parts  of  the  body  and  are  very  bad.   Sometimes  you  encountered 
so  many  clots  in  the  heart  that  you  couldn't  really  go  ahead  with 
the  procedure  of  mitral  valvotomy.   On  the  other  hand,  if  the  clots 
were  up  in  the  auricular  appendage,  near  where  you  had  to  work,  you 
could  flush  the  heart  out,  and  the  blood  gushing  out  would  sometimes 
carry  the  clot  with  it. 


131 


Hughes:    It  sounds  like  a  rather  gross  thing,  to  just  push  your  finger 

through  the  valve.   But  I  gather  that  the  split  was  rather  clean, 
and  that  the  valve  leaflets,  once  split,  would  appose  correctly? 

Gerbode:   Oh,  they  would  mostly  appose  correctly.   You  would  very  seldom 
produce  insufficiency.   The  main  problem  is  if  the  valve  is  so 
fibrotic  that  it  doesn't  move  properly,  so  that  it  doesn't  open. 
Even  though  you  split  it,  it'll  only  open  a  little  bit,  because  it's 
still  too  stiff.   Also  if  it's  too  stiff,  it  makes  it  much  more 
susceptible  to  fusion  again. 

Hughes:   Did  you  ever  have  to  cut? 

x 

Gerbode:   I  cut  a  few,  but  I  never  liked  to  do  it  very  much.   I  had  all  the 
knives  to  do  it  with,  but  I  didn't  use  them  very  often,  because  it 
was  always  dangerous  to  put  that  knife  in  there. 

Hughes:    I  understand  that  antibiotics  influence  the  very  character  of  the 
valve,  that  before  antibiotics  came  into  use,  calcification  of  the 
valve  itself  tended  to  be  much  more  severe. 

Gerbode:   I  don't  know  that  antibiotics  were  really  responsible  for  that. 

I  think  antibiotics  stopped  the  course  of  rheumatic  heart  disease. 

Hughes:   Ah,  so  the  problems  didn't  go  on  as  long. 

Gerbode:   They  didn't  go  on  as  long,  or  never  appeared.   If  you  give  antibiotics 
to  a  patient  with  a  certain  type  of  strep  throat,  then  he  won't  get 
rheumatic  fever.   That's  why  the  incidence  is  going  down. 

Hughes:   At  some  state  you  must  have  been  dealing  with  patients  that  had  had 
rheumatic  fever  before  antibiotics  came  into  use. 

Gerbode:   We  didn't  have  as  many  children  with  rheumatic  heart  disease  as  is 
found  in  many  other  countries.   For  example,  the  Eskimos  have  quite 
a  bit  of  rheumatic  heart  disease  in  children.   In  certain  other 
foreign  countries,  this  is  true,  too.   It's  very  difficult  to  take 
care  of  those  patients,  because  they  get  a  severe  form  of  valvular 
disease.   You  can't  use  a  palliative  operation  very  much  on  them. 
You  have  to  put  a  valve  in  some  of  them  when  they're  a  child,  and 
we  don't  like  to  do  that.   If  you  put  a  valve  in  a  child,  you  have 
to  expect  it  to  last  a  long,  long  time,  and  most  valves  probably 
won't  last  that  long.   Then,  if  it's  a  mechanical  valve,  one  has  to 
give   cumadin  or  a  cumadin-like  drug  to  prevent  clotting  on  the 
valve.   With  Eskimos  and  Indians  and  some  other  people,  it's  almost 
impossible  for  them  to  regulate  the  dosage  very  well. 


132 


Hughes:   Why  is  that? 

Gerbode:  They  live  in  an  igloo  somewhere,  and  they  can't  get  in  and  get  a 

test  done  very  often.   Then  they  don't  understand  that  you  can  take 
too  much  of  the  drug  and  make  matters  much  worse. 

I  remember  one  child  living  way  up  in  northern  Alaska  in  whom 
I  had  to  put  a  valve.   The  child  was  brought  down  to  Anchorage 
bleeding  from  every  orifice  and  requiring  massive  blood  replacement 
and  everything  else.   The  mother  said,  "The  little  girl  was  not  doing 
very  well,  and  I  thought  if  I  gave  her  more  of  the  medicine,  she'd  do 
better." 


Mitral  Stenosis:  Patient  Selection 


Hughes:   One  other  statement  from  one  of  your  papers,  this  one  from  California 
Medicine  in  1951.*  You  say  that  the  mortality  rate  for  mitral 
surgery  varied  directly  with  the  degree  of  morbidity  of  the  patient. 

Gerbode:  That's  true. 

Hughes:   That  leads  us  into  the  question  of  patient  selection,  and  I  believe 
you  established  fairly  early  on  the  optimal  age  range  from  mitral 
operations. 

Gerbode:  When  we  began  talking  about  mitral  stenosis,  I  think  we  said  we 
didn't  want  to  operate  on  anyone  over  forty-five,  no  one  with  a 
history  of  thromboembolism,  and  nobody  in  atrial  fibrillation. 
These  were  the  criteria.   Well,  as  time  went  on,  those  were  the 
patients  we  were  operating  on  most  of  the  time.   Just  the  reverse. 

Hughes:   Why? 

Gerbode:   Because  they  were  the  sickest,  and  they  needed  an  operation  more 
than  anybody  [else].   Most  of  the  patients  ended  up  by  being  over 
thirty-five  or  forty,  and  most  of  them  were  in  atrial  fibrillation, 
and  many  of  them  had  thromboembolism.  We  also  were  afraid  of  heart 
failure  in  the  very  beginning.   But  we  very  quickly  realized  that 
one  of  the  main  reasons  for  operating  on  the  patients  was  heart 
failure. 

Hughes:   Does  that  pretty  well  cover  mitral  stenosis? 


*F.  Gerbode,  "The  Surgical  Treatment  of  Acquired  Heart  Disease," 
California  Medicine,  1951,  75:185-188. 


133 


Gerbode:   Yes. 

Hughes:   Were  you  doing  a  lot  of  cases  of  mitral  stenosis? 

Gerbode:   Yes,  it  was  the  most  frequent  operation.   But  even  now  there  are 
a  lot  of  operations  for  mitral  and  aortic  valve  disease  that  are 
being  done  in  all  the  units  in  the  country  and  in  the  world, 
because  a  lot  of  the  patients  in  whom  we  had  done  the  palliative 
operation  of  mitral  valvotomy,  are  coming  back  now  with  more 
fibrosis  or  calcification,  and  they  require  an  open  heart  operation 
and  a  valve.   So  there  are  a  lot  of  repeat  operations  being  done, 
and  then,  quite  a  few  people  are  coming  in  who  avoided  operations 
all  these  many  years  because  their  doctors  just  didn't  believe  in 
having  them  operated  upon.   So  they  come  in  at  sixty-five  or  seventy 
requiring  a  valve  replacement.   We  do  these  cases  without  much  worry 
any  more,  because  we  can  manage  most  of  them. 


Heart  Valve  Replacement* 


Gerbode:   We  very  early  realized  in  the  '50s  that  we'd  have  to  replace  valves. 
So  I  had  a  fellow  by  the  name  of  Franz  Segger  start  working  on 
making  an  artificial  [aortic]  valve.   We  had  models  made,  and  we 
finally  made  a  valve  out  of  plastic  material,  which  looked  and  functioned 
like  a  human  valve.   But  we  didn't  know  how  long  it  would  last. 
However,  I  had  several  very  sick  patients  who  were  dying  from 
valvular  disease,  so  I  used  it  on  several  of  these  people.   It 
functioned  perfectly  for  about  a  year  and  a  half  or  two  years,  and 
then  it  fell  apart.   You  can  do  a  certain  amount  of  investigating 
in  animals,  but  you  really  have  to  try  it  on  a  human  eventually. 

Later  on  in  the  laboratory  we  made  pig  valves ,  and  we  sterilized 
the  pig  valves  with  formaldehyde,  which  we  found  was  not  the  chemical 
to  use.   Later  on  it  was  shown  that  glutaraldehyde  was  the  aldehyde 
of  choice.   This  was  developed  by  Alain  Carpentier  in  Paris  and  a 
number  of  others.   Glutaraldehyde  is  the  kind  of  aldehyde  they  use 
to  cure  leather  so  it'll  stay  soft   and  pliable.   This  was  adopted 
by  certain  people  and  proven  to  be  quite  good.   Most  of  the  pig 
valves,  other  animal  valves  and  pericardial  valves  that  are  made  now 
are  sterilized  and  cured  with  glutaraldehyde,  with  various  pH 
regulations  and  so  forth.   Virtually  thousands  of  these  have  been 
put  in  patients. 


*This  section  was  moved  from  the  session  recorded  on  9/27/83.   See 
the  session  recorded  on  5/15/84,  pp.  362-364,  for  further  discussion 
of  heart  valves. 


134 


Gerbode:  Mr.  Bramson  also  worked  on  an  artificial  valve  on  his  own.   I  didn't 
get  him  started  on  it;  Jack  Osborn  got  him  started  on  it.   It  was 
not  feasible,  because  the  way  he  wanted  to  mount  it  in  the  aortic 
root  was  not  biologically  satisfactory.   We  never  used  it  clinically. 

Hughes:   It  was  not  just  a  matter  of  fit? 

Gerbode:   No,  it  was  a  matter  of  it  not  being  designed  so  that  it'd  become 
part  of  the  patient's  tissues. 

We  put  in  a  certain  number  of  these  pig  valves  cured  with 
peraldehyde  really  quite  early  in  the  business,  long  before 
glutaraldehyde  came  into  being,  and  I  could  see  that  there  might  be 
a  big  advantage  in  using  tissue  valves.   So  I  organized  a  world 
tissue  valve  conference,  which  we  set  up,  with  NIH's  backing,  at 
Silverado.*  They  brought  surgeons  from  England,  Norway,  Australia, 
and  New  Zealand  for  a  three-day  conference  on  tissue  valves. 

Hughes:   When  was  this? 

Gerbode:   I've  forgotten.   The  '60s  sometime.   This  was  published  by  NIH.   But 
the  only  thing  that  came  out  of  it  really  was  the  fact  that  it  looked 
as  though  glutaraldehyde-preserved  tissue  valves  might  be  the  best. 

Hughes:   Was  there  a  debate  at  that  time  about  the  virtues  of  the  human  donor 
valve  as  opposed  to  an  artificial  or  even  an  animal  valve? 

Gerbode:   The  whole  discussion  at  this  conference  was  [about]  different  kinds 
of  tissue  valves.   People  were  making  them  out  of  pericardium  and 
fascia  lata.   I  did  about  twenty  some-odd  fascia  lata  valves,  taking 
fascia  lata  off  the  side  of  the  thigh  and  making  a  valve  in  the 
operating  room. 

Hughes:   What  gives  it  structure? 

Gerbode:   Fascia  lata  is  very  strong.   It's  a  tendonous  type  of  material. 

Hughes:    Can  you  describe  the  valve? 

Gerbode:  The  valve  looked  like  a  human  valve.   We  had  a  little  cusp,  and  we 
sewed  it  together  in  the  operating  room  and  made  it  the  same  size 
as  the  patient's  valve. 

Hughes:   Was  the  main  virtue  of  this  technique  that  there  was  no  problem  with 
rejection? 


*The  First  International  Workshop  on  Tissue  Valves,  Silverado, 
California,  October  4  and  5,  1969. 


135 


Gerbode:   We  thought  this  would  be  the  big  thing.   It  was  a  strong  material, 
and  it  came  from  the  same  person,  so  we  thought  it  might  be  quite 
good.   The  early  work  on  this  was  done  by  Marian  lonescu.   He  is 
a  very  innovative  surgeon  in  Leeds.   He  had  put  in  quite  a  few  of 
them  there,  and  he  claimed  a  very  early  success.   Well,  the  ones 
that  I  put  in,  about  twenty  of  them,  I  guess,  all  finally  became 
calcified  or  fell  apart  after  a  year  or  so.   So  that  didn't  turn 
out  to  be  so  good.   They  had  to  be  replaced  with  other  valves,  which 
fortunately  were  coming  along  at  that  time. 

Then  ball  valves  were  developed.   The  first  one  was  developed 
by  Dwight  Harken  in  Boston.   The  Edwards  Laboratories  then  worked 
on  another  type  of  ball  valve  with  Albert  Starr  in  Portland,  and 
they  produced  a  Starr-Edwards  ball  valve  which  was  a  silastic  valve 
in  a  metal  cage.   This  was  the  valve  of  choice  for  several  years. 
Some  people  still  use  them. 

Hughes:  Is  that  the  one  that  makes  a  lot  of  noise? 

Gerbode:  It  clicks,  all  right. 

Hughes:  Did  you  ever  use  that? 

Gerbode:  Yes.   We  put  in  a  lot  of  them. 

Hughes:  What  is  the  lifespan  of  those  valves? 

Gerbode:   Some  have  been  in  for  a  long  time.   I've  got  some  in  for  fifteen 

years.   The  early  silastic  ball  wore  out  or  fragmented,  and  it  would 
escape  from  the  little  cage  and  produce  a  very  serious  insufficiency, 
and  then  you'd  have  to  find  this  ball  valve  in  the  system  somewhere 
and  remove  it.   Usually  it  was  in  the  aorta.   Later,  better  material 
was  developed  which  lasted. 

Hughes:   Are  these  all  aortic  valves  that  you're  talking  about? 

Gerbode:   No,  mitral  valves,  too.   So  anyway,  we  used  that  Starr  valve,  and 
they  finally  changed  the  type  of  material  in  the  ball  so  it  was 
harder  and  wouldn't  wear  out.   At  the  same  time,  in  Sacramento, 
another  group  produced  another  type  of  ball  valve  in  a  cage,  the 
Smelloff-Cutter  valve,  and  that  probably  in  many  respects  is  the  best 
one. 

However,  with  all  the  mechanical  valves,  regardless  of  which 
one,  the  surgeon  is  obliged  to  use  anticoagulant  drugs,  because  the 
incidence  of  thrombi  forming  on  these  valves  is  pretty  high 
without  the  use  of  cumadin. 


136 


Hughes:   Why  more  so  than  with  a  human  valve? 
Gerbode:   Tissue  valves  are  not  so  thrombogenic. 
Hughes:   But  why? 

Gerbode:  I  guess  metal,  struts  and  things  like  that,  produce  more  turbulence, 
and  that  favors  stagnation  and  thrombosis.  I  think  there's  a  little 
bit  of  electricity  involved,  too. 

Hughes:   Was  there  ever  a  problem  with  hemolysis  with  the  artificial  valve? 

Gerbode:  Yes,  there  still  is.  An  artificial  valve  which  is  not  functioning 
properly  or  which  is  leaking  will  produce  hemolysis. 

Hughes:   Is  the  leakage  usually  between  the  artificial  valve  and  the  tissue? 

Gerbode:  It  can  be  there,  or  at  the  edge  of  the  valve,  where  the  ball  or 
disk  seats  on  the  valve.  If  it's  not  fitting  properly,  there's 
turbulence  over  that  area,  which  is  very  damaging  to  red  cells. 

Hughes:   So  that's  a  problem  with  the  manufacture  of  the  valve. 

Gerbode:  No,  not  necessarily.   It's  a  problem  of  not  fitting  the  valve 
properly.   Sometimes  it  is  the  manufacturer,  but  rarely. 

Hughes:  Does  that  mean,  then,  that  the  alignment  of  the  valve  in  the  orifice 
is  extremely  important? 

Gerbode:  Yes.   It  has  to  be  seated  perfectly  so  it  won't  leak.   All  these 

valves  now  have  a  cloth  cuff  around  them.  The  cloth  is  used  so  that 
the  patient's  tissues  will  grow  into  that  cuff  and  hold  it  in  there. 
Sometimes  healing  isn't  very  satisfactory,  and  that's  why  it  leaks. 

Hughes:  In  the  early  days  they  didn't  use  cloth? 
Gerbode:  They  used  cloth  from  the  very  beginning. 
Hughes:  How  long  does  it  take  for  the  invasion  of  the  tissue? 

Gerbode:   It  starts  right  away.   In  a  couple  of  months  it's  pretty  solidly 
embedded. 

Hughes:   Did  you  ever  have  a  strong  feeling  of  the  artificial  valve  versus 
the  tissue  valve  being  superior? 


137 


Gerbode : 


Hughes : 
Gerbode: 


Hughes: 
Gerbode: 

Gerbode: 


Hughes : 
Gerbode: 

Hughes : 
Gerbode: 

Hughes : 
Gerbode: 


I  always  thought  that  tissue  valves  were  going  to  be  the  best 
eventually,  and  that's  why  we  made  some  out  of  the  patient's 
tissue  and  studied  some  in  the  laboratory.   Any  mechanical  device 
in  the  circulatory  system  has  certain  inherent  disadvantages. 
True,  there  have  been  thousands  of  mechanical  valves  put  in  patients, 
and  for  the  most  part,  about  75  percent  of  them  have  lasting  virtue 
and  a  very  low  failure  rate;  about  75  percent  of  them  survive  more 
than  five  years  with  a  low  incidence  of  thrombotic  complications. 
But  there  is  always  some  instance  of  thrombotic  complications,  and 
they  all  have  to  take  ant i coagulation  drugs,  cumadin. 

Forever? 

Forever.   There  are  a  certain  number  of  incidences  of  bleeding  from 
cumadin.   In  our  own  service  here,  I  know  of  several  disastrous 
hemorrhages  from  patients  taking  too  much  cumadin  and  not  regulating 
it  properly,  and  getting  brain  hemorrhage  and  other  big  hemorrhages. 
You  have  to  be  very  careful. 

Tissue  valves  may  have  to  be  replaced  in  a  few  years? 

Well,  the  tissue  valves  are  almost  as  good  and  [of]  lasting  quality 
as  the  artificial  valves. 

H 

One  basic  reason  is  that  the  tissue  is  made  inert  by  being  cured 
by  glutaraldehyde,  so  it's  like  a  little  piece  of  flexible  leather, 
you  might  say.   And  this  is  true  whether  it's  pericardium  or  any 
other  tissue. 

Did  you  use  donor  valves  to  any  extent? 

I  only  put  a  few  fresh  aortic  valves  in.  The  ones  I  put  in  actually 
have  lasted  very  well.  I  have  one  in  an  Indian  doctor,  for  example. 
It's  [been]  about  fifteen  years  now;  he's  still  doing  well. 

Why  did  you  put  so  few  in? 

They're  hard  to  get,  and  we  didn't  have  a  massive  supply  available, 
and  we  had  a  massive  number  of  patients  to  be  operated  upon. 

Do  you  think  that  covers  valve  surgery? 

I  haven't  talked  about  all  the  various  people  who've  worked  on  this 
problem.   There's  Carpentier  in  Paris  at  the  Broussais  Hospital  who's 
made  some  very  good  contributions.   And  Marian  lonescu  in  Leeds  has 


138 


Gerbode:   continued  to  make  very  valuable  contributions.  His  present  valve 

is  made  out  of  pericardium,  which  is  cured  again  with  glutaraldehyde. 
It's  seemingly  lasting  better  than  some  of  the  pig  valves. 

Hughes:   Why  is  a  pig  the  animal  of  choice? 

Gerbode:   [Its]  valve  is  like  a  human  valve.   It's  easy  to  get  a  pig's  valve. 
A  great  many  of  them  are  coming  from  the  Philippines  now. 

Hughes:   Why  is  that? 

Gerbode:   Because  they  eat  a  lot  of  pork  out  there. 

Hughes:   Does  size  have  anything  to  do  with  it? 

Gerbode:  Yes,  they're  sized.   There's  a  pretty  standard  size  for  most  adults. 
But  then  for  children  and  some  adults  you  have  to  have  different 
sizes. 


The  Korean  War  and  Its  Aftermath 


Hughes:   Is  it  too  big  a  question  to  get  into  the  impact  of  the  Korean  War? 

Gerbode:   I  can  probably  cover  that.  The  Korean  War  was  a  war  which  nobody 

liked  very  much.   I  guess  you  could  philosophize  about  why  we  should 
have  done  anything  about  it.   But  having  gotten  into  it,  then  we  had 
a  lot  of  troops  over  there  who  were  getting  sick  and  getting  hurt. 
The  surgeon  general  of  the  army  wanted  to  be  sure  that  the  troops 
were  getting  modern  medicine.   So  he  asked  people  in  some  of  the 
university  centers  if  they  would  go  over  to  have  a  tour  of  duty  and 
inspect  the  hospitals  and  make  any  suggestions  about  improving  the 
care  of  the  soldiers.  Franny  Moore  was  one  that  was  sent  over  from 
Harvard,  John  Howard  from  Philadelphia,  and  a  number  of  others.   I 
guess  there  were  quite  a  few  who  were  asked  but  didn't  want  to  do 
it,  didn't  want  to  leave  their  civilian  work.   I  was  asked  by  the 
surgeon  to  do  it ,  and  I  was  very  happy  to  do  it . 


Service  as  a  Brigadier  General 


Gerbode:   So  I  went  over.   I  was  assigned  a  colonel  in  the  regular  medical 

corps  of  the  army  to  stay  with  me  the  whole  time  and  get  me  through 
all  the  various  paperwork  that  was  necessary  to  move  me  around.   I 


139 


Gerbode:   was  at  that  time  a  lieutenant  colonel  in  the  army  reserve.   But  to 
move  me  around  in  Korea,  1  had  to  have  a  title  a  little  bigger 
than  that,  so  I  could  get  priority  on  airplanes  and  helicopters. 
So  the  surgeon  general  said,  "Don't  tell  anybody  about  your  being  a 
lieutenant  colonel  in  the  reserve;  I'm  going  to  make  you  a  temporary 
brigadier  general  [laughter]  so  you  can  get  around."  So  I  was  a 
brigadier  general  during  the  Korean  War. 

Hughes:   They  withdrew  that  title  after  the  war? 

Gerbode:   Yes.   There  wasn't  any  necessity  to  keep  it  going.   Actually,  when 
I  came  back,  I  decided  that  if  they  thought  enough  of  me  to  make 
me  a  general  when  they  wanted  me,  that  there  wasn't  much  point  in 
my  retaining  a  lieutenant  colonel's  commission,  because  all  I  would 
do  is  make  myself  susceptible  to  being  drafted.   Then  when  I  was, 
I'd  be  brought  in  as  a  lieutenant  colonel,  whereas  if  they  really 
wanted  me,  and  I  had  no  title,  they'd  make  me  a  general.   I  think  my 
reasoning  was  valid. 

I  went  to  Seoul  first.   The  ritual  was  to  visit  all  the 
hospitals  and  to  have  ward  rounds  and  give  a  few  lectures.   I  had  a 
few  subjects  I  talked  about,  resuscitation  and  shock  and  things 
that  were  common  to  the  treatment  of  seriously  wounded  soldiers.   I 
would  give  these  lectures  if  they  were  necessary.   But  mainly  I 
would  go  on  ward  rounds  with  the  young  surgeons  who  were  doing  most 
of  the  work — they  were  mostly  captains — and  see  how  they  were 
handling  the  wounded,  and  make  suggestions  if  I  thought  they  were 
pertinent.   I  did  this  in  virtually  all  the  army  hospitals,  and 
some  of  the  navy  hospitals,  in  Korea. 

Hughes:   Did  you  find  that  people  were  pretty  much  up  to  date? 

Gerbode:   Yes,  they  were.   Some  curious  things  happened  though.   I  ran  into 
one  station  hospital  where  they  had  a  young  captain  who  had  been 
trained  in  a  certain  hospital  in  the  Philadelphia  [area]  where 
the  professor  had  used  fine  wire  in  most  operations. 

II 

Gerbode:   Well,  wire  is  fine  in  certain  situations,  but  it's  not  very  good  in 
traumatic  wounds,  because  eventually  it  has  to  be  taken  out.   It's 
irritating.   I  tried  in  my  ward  rounds  to  try  to  dissuade  him  from 
using  it.   He  really  didn't  think  very  much  of  my  advice.   I  said, 
"When  I  go  back  to  the  base  in  Japan,  what  would  you  like  to  have 
me  have  them  send  you?"  He  said,  "Just  have  them  send  me  some  more 
wire."   [laughter] 


140 


Gerbode:   It  was  interesting.   It  was  during  the  wet  weather,  so  most  of  the 
lectures  and  subjects  were  handled  in  tents,  just  like  MASH.   The 
only  difference  was  that  all  the  little  things  that  MASH  was  involved 
with — sex  and  everything — if  they  went  on,  I  didn't  see  them,  and 
there  weren't  a  lot  of  foolish  commanding  officers.  All  of  them  were 
sensible  people. 

Mainly,  I  guess,  what  I  did  was  make  little  suggestions  about 
things.   I  wrote  a  big  report  at  the  end.   But  the  thing  that  I 
really  was  very  interested  in  was  how  they  took  care  of  the  wounded 
up  at  the  front.   To  do  that,  I  had  to  go  up  in  a  helicopter.   So 
they  assigned  a  fellow  by  the  name  of  Tex.   (Anybody  from  Texas  is 
called  Tex.)  He  was  the  helicopter  pilot,  and  he  took  me  around 
to  various  front-line  units,  flying  under  the  artillery  barrage. 
You'd  hear  the  gun  go  off  on  your  right,  and  then  the  shell  would 
go  over  and  land  on  the  enemy  on  the  other  side,  and  you  kept 
thinking,  "I  hope  they  don't  aim  too  low."   [laughter] 

But  anyway,  they  would  go  up  there  with  these  helicopters,  and 
they  strapped  the  wounded  on  the  outside  on  little  platforms,  and 
then  flew  them  back  within  an  hour  or  so  of  being  wounded.   It  was  a 
very  efficient  way  of  doing  it. 

Hughes:   Was  the  helicopter  used  in  World  War  II? 

Gerbode:  No,  they  were  started,  but  we  didn't  see  many  helicopters  over  there. 
But  they  used  them  a  lot  in  Korea.   It  was  a  great  way  of  getting 
around,  when  they  wanted  to  move  me  from  one  place  to  another.   It 
was  just  fifteen  to  twenty  minutes  in  a  helicopter,  whereas  it  might 
have  taken  hours  on  a  road. 

Hughes:   A  lot  of  lives  were  saved. 

Gerbode:  A  lot  of  lives  were  saved.   [If  it  was]  raining,  they'd  cover  up 

[the  wounded]  with  tarpaulins  and  put  them  on  these  platforms  on  the 
side  of  the  helicopter  and  take  them  right  out.  While  on  the 
helicopter,  they  would  receiving  an  intravenous  of  blood  or  saline, 
if  necessary,  while  they  were  being  flown  back  to  the  hospital. 

Hughes:   Was  the  setup  similar  to  World  War  II? 

GerboJe:  Yes,  but  it  was  more  like  it  was  at  the  end  of  the  war,  because  at 
the  beginning  of  the  war,  it  was  a  mess.   At  the  end  of  the  war, 
these  forward  hospitals  really  were  pretty  well  standardized  and 
were  very  efficient.   They  had  good  instruments,  plasma,  antibiotics, 
and  blood.   They  knew  what  they  were  doing. 


141 


Gerbode:   It's  interesting,  though,  that  in  both  wars  it  wasn't  the  regular 
army  that  was  doing  this.   The  regular  army  was  in  all  the  command 
positions.   But  the  work  was  mostly  being  done  by  reserve  officers. 
The  regular  army  could  never  have  done  the  job  in  World  War  II. 

When  I  came  back  from  the  Korean  War,  it  was  very  hard  to  find 
a  regular  medical  officer  who'd  been  over  there.  They  were  all  in 
base  hospitals  starting  training  programs  in  thoracic  and  cardio 
vascular  and  general  surgery,  and  not  over  there  in  the  front  line. 
There  wasn't  much  future  in  doing  that. 

Hughes:   Now,  are  you  speaking  just  about  medicine? 
Gerbode:   Yes,  I'm  speaking  about  medicine  and  surgery. 

Hughes:   After  the  Korean  War,  I  know  you  wrote  a  number  of  papers  on  repair 
of  war  injuries  to  the  major  blood  vessels. 


John  Howard:   Blood  Replacement 


Gerbode:  There  were  two  fellows  who  really  made  a  lot  of  contributions  to  the 
understanding  of  the  wounded  during  the  Korean  War.   One  was  John 
Howard.   He  was  the  one  who  made  the  observation  that  [when  there 
was]  a  lot  of  bleeding,  you  had  to  give  [the  patient]  more  blood 
back  than  the  blood  that  was  lost.   This  was  a  very  important  observa 
tion,  because  it  meant  that  blood  replacement  had  to  be  much  greater 
than  you  might  expect.   The  physiology  of  why  this  was  true  was  not 
understood.   It  probably  still  isn't  fully  understood.   But  the  body 
usually  needs  more  blood  than  it  has  lost.   John  Howard  [made]  a  lot 
of  physiological  observations  over  there  in  the  field  which  were  very 
good.   He's  a  very,  very  nice  fellow,  lives  in  Philadelphia. 

Hughes:   How  did  he  even  come  to  that  concept? 

Gerbode:   He  found  out  that  by  the  time  they  replaced  all  the  blood  they 

thought  the  boy  had  lost,  that  he  still  had  a  low  blood  pressure, 
and  there  was  also  other  evidence. 

Hughes:   Ah,  so  they  put  a  little  more  in. 

Gerbode:   Well,  basically  that,  but  they  had  methods  of  studying  blood  volume, 
too,  which  refined  the  concept.   But  it  was  mainly  that  they  found 
they  had  to  give  more  blood.   Later  on  they  did  blood  volume 
observations,  which  made  it  more  scientific. 


142 


Frank  Spencer:   Early  Repair  of  Blood  Vessels  in  the  Field 


Gerbode:   Frank  Spencer  was  a  very  interesting,  very  nice  young  guy,  whom  I 

had  met  at  the  Oak  Knoll  Naval  Hospital,  when  he  went  into  the  navy 
service.   I  was  a  consultant  over  there.   Then  we  worked  together 
on  some  patients  at  the  naval  hospital.  He  went  over  [to  Korea]  on 
his  tour  of  duty  and  began  to  repair  arteries  in  the  field.   He  and 
a  couple  of  other  surgeons  were  very  influential  in  changing  the 
concept  of  early  repair  of  major  vessels  in  the  field.   That  was 
a  big  advance,  because  even  in  World  War  II  we  didn't  try  to  repair 
many  arteries.   We  tied  them  off.   Then  there  was  a  fixed  rate — for 
example,  with  a  leg  artery — of  amputation  for  gangrene,  at  certain 
levels.  We  did  repair  a  few  [vessels]  in  World  War  II  in  the  field, 
but  not  very  many. 


Vascular  Suture 


Hughes:   Was  that  just  a  conceptual  barrier  because  weren't  the  techniques 
adequate? 

Gerbode:   Oh,  the  techniques  were  there.   Nobody  I  guess  was  smart  enough  to 
apply  them.   See,  the  technique  of  vascular  suture  was  really 
started  in  Europe.   [Just  after  the  turn  of  the  century]  Alexis 
Carrel  saw  some  of  these  things  being  done  in  the  laboratory  by  the 
French,  and  he  came  to  the  Rockefeller  Institute  and  began  to  use 
vascular  suture  in  animals.   He  found  that  he  could  join  arteries 
together,  that  they  would  stay  together,  and  they  wouldn't  leak  and 
would  heal.   So  he  used  the  technique  to  transplant  organs.  He 
transplanted  a  heart  into  the  neck  of  a  dog  and  anastomosed  the 
vessels.   The  vessels  stayed  open,  and  the  heart  lived.   A  number 
of  his  experiments  of  this  type  were  responsible  for  his  getting  the 
Nobel  Prize.   These  are  techniques  which  young  residents  do  all  the 
time  now. 

Hughes:   Yes,  but  there  was  a  tremendous  gap  before — 

Gerbode:  Well,  that  is  true.   It  takes  almost  twenty  years,  almost  a  whole 

generation,  between  the  discovery  of  a  method  or  a  technique  and  its 
full  application. 

Hughes:   Do  you  think  that's  a  matter  of  one  generation  dying  off  and  a 
new  one — ? 


143 


Gerbode:   No,  it  just  takes  that  long  for  the  idea  to  sink  in.   Now,  the 

great  people  of  this  present  generation  are  the  ones  who  recognize 
those  things  which  are  all  about  us  now  and  start  doing  them  now 
rather  than  [waiting]  for  the  next  generation. 

Hughes:   Was  the  main  problem  the  fear  that  the  sutures  wouldn't  hold? 
Gerbode:   Yes,  they  didn't  think  they  could  do  it  technically. 

Hughes:   You  published  a  paper  on  coarctation  with  Geoffrey  Bourne  in  1951,* 
which  meant  you  did  the  operation  in  1951  or  1950,  very  soon  after 
the  first  operations  for  coarctation  had  been  done.   Was  that  a 
fear  of  yours?   I  would  think  that  suturing  the  aorta  would  be  one 
of  the  most  scary  things  to  do. 

Gerbode:   Yes.   The  difference  between  that  operation  and  suturing  an  artery 
in  a  wound  is  that  if  you  suture  it  in  a  wound,  you'd  feel  that 
maybe  the  wound  would  get  infected  and  then  the  arterial  suture 
would  break  open.   That  was  one  of  the  scary  things.   But  as  it 
happened,  there  are  methods  of  covering  that  arterial  repair  with 
a  flap  of  tissue,  and  then  also  being  sure  that  the  tissue  that  you 
used  was  absolutely  clean.   Also,  later  we  had  antibiotics.   We  had 
penicillin.   We  could  cover  infections  a  lot  better.   Those  were 
the  main  reasons.   But  I  think  just  the  fear  of  being  [un]able  to 
suture  it  together  and  the  fear  that  it  might  break  open  or  rupture 
was  something  you  had  to  overcome. 

Hughes:   Was  that  in  the  back  of  your  mind  when  you  first  started? 

Gerbode:   I  don't  know.  When  I  was  operating  on  children  for  congenital 
disease,  I  wasn't  really  thinking  very  much  about  war  surgery. 


Vein  Grafts 


Gerbode:   Later  on,  toward  the  end  of  the  Korean  War  and  in  Vietnam,  I  was 

still  a  consultant  for  the  navy,  so  they  had  me  over  at  the  Oak  Knoll 
Naval  Hospital  about  once  a  week  operating  on  arterial  injuries.   I 
was  doing  the  leg  repairs  over  there.   I  wrote  a  paper  on  it.** 


*"Surgical  treatment  of  a  case  of  coarctation  of  the  aorta  with 
unilateral  hypertension,  associated  with  ungovernable  tempers," 
British  Journal  of  Surgery,  1951,  38^3840386. 

**E.H.  Dickson,  T.E.  Ashley  and  F.  Gerbode,   "The  definitive  treat 
ment  of  injuries  to  the  major  blood  vessels  incurred  in  the  Korean 
War,"  Western  Journal  of  Surgery,  1951,  _5_2:625-634. 


144 


Hughes:    I  believe  that  was  the  one  where  the  cases  were  mainly  arteriovenous 
fistulas  and  aneurysms? 

Gerbode:  Yes.   I  did  some  vein  grafts  on  patients  who'd  had  ligation  of  major 
vessels,  and  I  put  a  vein  in  as  a  graft. 

Hughes:   I  noticed  that  in  some  cases  you  used  a  vein  graft  for  the  artery. 
Why  would  you  use  a  vein? 

Gerbode:   Because  there  wasn't  an  artery  available  to  put  in. 
Hughes:   Oh,  it's  as  simple  as  that!   [laughs] 

Gerbode:  And  also  the  fact  that  a  vein  is  usually  available.   For  example,  in 
all  these  coronary  bypass  operations  now,  where  they  jump  over  a 
diseased  portion  of  an  artery  to  the  heart,  they  use  a  vein  from 
the  leg. 

Hughes:   And  these  in  most  cases  were  autonomous  grafts? 
Gerbode:   Yes,  they're  from  the  same  patient. 
Hughes:   But  you  did  use  homografts  as  well? 

Gerbode:  No.  Well,  later  on,  when  I  set  up  a  graft  bank  at  the  Irwin  Blood 

Bank,  where  we  freeze-dried  arterial  grafts,  I  used  some  of  those  in 
patients  instead  of  veins. 

Hughes:   When  was  that? 

Gerbode:   Fifties,  after  the  war.   But  after  a  year  or  so,  we  saw  that  some 
of  those  grafts  became  calcified. 

Hughes:    Both  types  now? 

Gerbode:   No.   Mainly  the  homografts.   So  we  stopped  using  them.   At  that  same 
time,  we  began  to  use  cloth  grafts,  which  were  becoming  very  much 
available.*  The  first  cloth  grafts  were  made  out  of  nylon  at 
Columbia  mainly  by  a  fellow  by  the  name  of  [Arthur  B.]  Vorhees, [Jr.]. 
They  were  made  out  of  very  thin  nylon  cloth.  Later  on  even  lady's 
nylon  stockings  were  sewed  together  and  used — in  fact,  I  made  some 
myself  and  used  them  in  humans. 

Hughes:   Why  did  you  choose  nylon? 


*Part  of  the  discussion  of  cloth  grafts  was  moved  from  the  interview 
session  on  8/10/83. 


145 


Gerbode:   Because  it  was  thin  and  strong  and  easy  to  work  with.   But  we  found 
later  on  that  nylon  disappeared  in  the  body.   It  was  absorbed. 
After  a  year  or  two  these  grafts  would  get  soft  and  become  aneurisms 
or  would  get  weak.   So  it  was  later  that  dacron  was  used.   Dacron 
was  found  not  to  disappear  this  way.   This  again  was  based  on 
experimental  surgery.   This  was  all  found  in  animals. 

A  lot  of  the  best  research  on  cloth  grafts  was  done  by  Dr. 
[Michael  E.]  DeBakey.   He  quickly  saw  that  he  should  get  the  cloth 
manufacturers  interested  in  it,  which  he  did.   They  produced  some 
materials,  first  with  rayon  and  nylon,  and  then  later  dacron.   They 
found  that  rayon  and  nylon  didn't  last  long  enough;  they  got  soft 
and  broke.   But  dacron  lasted  indefinitely.   So  when  these  [dacron 
grafts]  became  available,  we  used  those  in  clean  wounds,  and  they 
still  do,  although  at  the  present  time,  it's  still  a  bit  better 
statistically  to  use  a  vein  for  a  graft  in  a  leg  than  it  is  to  use  a 
cloth  graft. 

Hughes:   Does  anybody  know  why? 

Gerbode:   Because  it's  living  tissue,  the  patient's  own  tissue. 

Hughes:   Then  why  wouldn't  that  apply  elsewhere? 

Gerbode:   Well,  that's  where  they're  using  them  mostly,  in  the  leg.   We  use 
them  everywhere — around  the  heart,  in  the  heart. 

Hughes:   And  calcification  isn't  a  problem? 
Gerbode:   No,  it  isn't. 

Hughes:    So  the  body  obviously  is,  in  a  certain  sense,  recognizing  that  the 
homograft  is  foreign. 

Gerbode:   Sure,  it's  a  form  of  rejection. 

Hughes:   Can  you  say  something  about  the  knowledge  in  those  days  of  the 
mechanism  of  rejection? 

Gerbode:   We  really  didn't  know  about  the  whole  field  of  rejection  until 
people  were  able  to  type  blood  and  tissues.   People  could  type 
tissues  to  find  out  whether  they  were  more  or  less  compatible  or 
completely  incompatible.   This  was  necessary  because  of  the  early 


146 


Gerbode:   techniques  of  using  renal  transplants.   They  found  that  if  they  could 
tissue  type  them,  and  found  that  they  were  compatible,  that  more 
grafts  would  take. 

Hughes:   So  it  was  renal  transplants — 

Gerbode:  The  renal  transplant  really  was  the  one  that  put  tissue  typing  on 
the  map. 

Hughes:   That  was  the  '60s?        . 
Gerbode:  Yes. 

Hughes:    So  you  didn't  have  any  sophisticated  system  when  you  first  started 
the  vein  grafts? 


Heart  Transplantation* 


The  Problem  of  Rejection 


Gerbode:  No.   Actually,  we  could  talk  about  heart  transplants  in  this  regard, 

too.   Dr.  [Norman]  Shumway  and  a  team  were  doing  cardiac  transplantation 
in  our  old  [dog]  laboratory  on  Sacramento  Street  very  early  on,  using 
hypothermia,  just  cooling  the  heart  down  and  then  transplanting 
it  quickly.   I  kept  watching  these  procedures,  and  I  could  see  that 
technically  it  was  feasible,  all  right,  but  I  kept  raising  the 
question  of  rejection.   I  said,  "There's  not  much  point  in  doing  all 
this  if  the  body  is  going  to  discard  the  heart  very  quickly." 

Dr.  Shumway  believed  that  sooner  or  later  they  would  find  out 
a  way  of  controlling  rejection,  which  is  more  or  less  true  right  now, 
because  they  use  the  same  techniques  for  blood  and  tissue  typing, 
as  is  used  for  renal  transplants.**  That  was  closer  to  what  they 
wanted.   There  was  one  very  well  known  surgeon  in  the  South  who  said, 


*See  pp.  194-196,  354-355,  and  468-469, 

for  further  discussion  of  heart  transplantation. 

**Further  discussion  of  Shumway 's  work  on  heart  transplantation  occurs 
in  the  session  recorded  on  9/27/85,  pp.  251-253. 


147 


Gerbode:   "I  don't  think  there's  anything  to  this  tissue  typing.   I  think  the 
main  thing  is  just  to  put  that  heart  in."  Well,  he  put  about  twenty 
of  them  in,  and  they  all  died.   But  he's  that  kind  of  a  fellow. 

Hughes:   This  isn't  a  Texan  now? 
Gerbode:   Well,  I'm  not  saying. 

More  recently  drugs  have  been  used  to  control  rejection.   We 
can  talk  about  that  later  sometime  perhaps,  although  that's  not 
much  I  have  anything  to  do  with,  because  I  never  got  into  transplan 
tation. 

i 
Hughes:   Why? 

Gerbode:   I  stopped  operating  a  few  years  ago.   We  did  a  lot  of  experiments 
in  cardiac  transplantation  in  this  lab  in  1975-76-77.   The  animals 
would  live  for  a  certain  length  of  time,  but  the  hearts  would  be 
rejected.   And  there  wasn't  anything  we  knew  about  in  an  animal  that 
could  keep  that  [from  happening].   So  it  was  kind  of  a  futile  thing 
to  me  at  the  time. 

Hughes :   Yet  other  people  were  using  the  technique  on  humans ,  is  that  not 
true?   Christiaan  Barnard? 

Gerbode:   Yes,  they  were.   Shumway  was  using  it  on  humans  then,  too.   But  the 
success  really  got  going  when  they  began  to  use  drugs  to  help 
prevent  the  rejection  phenomenon  and  improved  tissue  typing. 

Hughes:    So  that's  what  held  you  back? 

Gerbode:   Yes,  I  couldn't  see  any  way  of  controlling  [rejection]. 


Norman  Shumway 


Hughes:   Could  you  wind  up  by  saying  a  little  about  your  association  with 
Shumway? 

Gerbode:   Norm  was  trained  in  Minneapolis.   He  didn't  have  a  full  residency 
in  surgery  according  to  the  regular  method  of  training  a  surgeon. 
He  was  exposed  to  hypothermia  as  a  technique  for  doing  open  heart 
surgery  through  the  work  of  [John  F. ]  Lewis,  who  was  then  on  the 
faculty  at  the  University  of  Minnesota.   Norm  came  out  here  looking 
for  a  place  to  work.   Dr.  [Victor]  Richards  was  the  acting  chief  of 


148 


Gerbode:   surgery  at  that  time,  and  he  gave  him  the  opportunity  to  work  in  our 
old  dog  lab,  where  I  was  working,  too.   Norm  started  doing  cold 
arrest  of  the  heart — a  technique  of  cooling  the  heart  down,  so  it 
could  be  stopped  and  then  operated  upon — and  developed  a  technique 
for  that  which  he  used  later  for  a  long  time  on  humans.   The  rest  of 
us  used  it ,  too ,  to  a  certain  extent . 

He  also  kept  plugging  away  at  transplanting  dog  hearts.   Then 
he  started  a  unit  of  cardiac  surgery  at  Children's  Hospital,  which 
was  really  in  competition  with  our  unit  here.   But  there  wasn't  any 
place  for  him  to  work  other  than  over  there.   So  he  did  a  few  cases 
over  there.   But  they  never  really  had  a  good  team  at  Children's 
Hospital.   It  wasn't  organized  as  a  big  team,  and  every  operation 
was  kind  of  a  new  experience. 


Fallout  from  Surgical  Advances 


Gerbode:  One  of  the  most  important  points  about  Norm  Shumway  continuing  his 
transplant  work  in  the  face  of  no  real  ability  to  cope  with  the 
rejection  phenomenon  is  that  when  surgeons  demonstrate  they  can  do 
something,  it  stimulates  a  lot  of  activity  around  that  particular 
procedure.   Now,  when  it  was  demonstrated  that  we  could  repair  the 
inside  of  the  heart,  or  the  heart  itself,  it  stimulated  a  tremendous 
amount  of  work  among  the  cardiologists.   As  I  mentioned  to  you 
before,  it  made  cardiology  a  different  thing  entirely.   It  taught 
the  anesthesiologists  a  whole  different  way  of  dealing  with  anesthesia. 
It  taught  cardiac  physiologists  all  the  principles  of  dealing  with 
seriously  ill  patients.   It  brought  out  all  the  developments  in 
better  resuscitative  care  of  pulmonary  insufficiency,  and  so  forth. 

So  the  fact  that  the  surgeon  could  demonstrate  repeatedly  that 
[transplantation]  was  technically  feasible  put  the  burden  of 
experimentation  and  development  on  the  others  who  could  support 
this  venture.   In  other  words,  if  you  could  conquer  the  rejection 
phenomenon,  it  was  apparent  that  you  could  transplant  almost  any 
organ  except  the  brain  and  spinal  cord. 

Hughes:   And  that  was  apparent  early  on,  was  it  not? 

Gerbode:   It  was  apparent  as  soon  as  surgeons  demonstrated  they  could  do  it. 

Hughes:   Carrel  had  shown  that  way  back  in  the  early  years  of  the  century. 


149 


Gerbode:   [He]  did.   It  took  twenty  years  for  them  to  catch  up  with  what 
Carrel  was  saying.   But  the  same  thing  is  true  about  vascular 
suture  and  arterial  repair.   As  soon  as  surgeons  demonstrated  that 
they  could  repair  arteries  and  help  patients  with  arteriosclerotic 
occlusive  disease  with  grafting,  then  this  brought  out  the  production 
of  vascular  grafts  made  out  of  fabrics — the  biggest  industry  of  this 
kind  in  the  whole  world.   There  isn't  any  country  that  can  touch  us 
in  this  industry  of  making  grafts  out  of  prosthetic  material. 


Consultant  Positions//^ 
[Interview  6:   August  24,  1983] 


Oak  Knoll  Naval  Hospital,  Oakland 


Gerbode:   After  the  war,  both  the  army  and  the  navy  recruited  some  of  the 
people  who  had  been  in  the  war  to  be  consultants.   The  first 
government  group  to  ask  me  to  become  a  consultant  was  the  United 
States  [Oak  Knoll]  Naval  Hospital  in  Oakland.   I  guess  they  invited 
me  over  because  I'd  already  established  myself  to  a  certain  extent 
in  vascular  work  and  was  doing  the  beginnings  of  heart  surgery.   They 
had  a  fair  number  of  patients  there  who  were  service  people  who  had 
vascular  and  heart  problems.   I  would  go  over  once  a  week  and 
lecture  and  occasionally  would  do  an  operation.   In  the  beginning 
[I  would]  operate  perhaps  once  a  week  on  the  same  day  as  doing  a 
lecture.   I  found  this  very  rewarding.   I  liked  going  over  there, 
because  they  were  very  fine  people,  and  they  approached  everything 
very  much  on  an  academic  level.   The  pay  was  very  small,  fifty 
dollars  a  day. 


Letterman  General  Hospital,  San  Francisco 


Gerbode:   I  felt  I  was  continuing  to  do  my  duty  toward  the  armed  forces. 

Then  a  year  later,  I  guess  some  of  the  army  people  realized  that 
having  been  in  the  army  for  three  and  a  half  years,  it  was  rather 
strange  that  I  was  being  a  consultant  for  the  navy.   So  the  army 
invited  me  to  be  a  consultant  at  Letterman.   This  was  very  good, 
because  I  could  easily  get  there,  and  the  people  who  were  in  charge 


150 


Gerbode:  were  very  compatible.   I  started  operating  at  Letterman  as  well 

and,  in  the  beginning,  teaching  them  how  to  do  major  vascular  work 
and  some  cardiac  work. 

Hughes:   Did  you  go  on  a  regular  basis? 

Gerbode:  About  once  a  week  I'd  go  there  for  a  half  a  day  and  would  lecture 

or  go  to  their  conferences,  and  then  operate  when  the  occasion  arose. 
Now,  of  course,  they  have  a  full  training  program  in  thoracic  and 
cardiovascular  surgery.   I  got  there  only  as  a  consultant  on  call, 
not  operating  any  more.  All  during  this  early  period,  some  of  the 
people  from  the  army  and  the  navy  would  come  to  our  conferences  here , 
which  was  then  Stanford,  as  part  of  their  educational  program. 

Hughes:   How  did  that  arrangement  arise? 

Gerbode:   I  arranged  it.   I  just  invited  them  to  come,  and  they  would  come 
once  a  week,  mainly  to  our  catheterization  conference,  where  we 
would  discuss  cases.   This  was  also  a  very  nice  arrangement.   I 
am  still  a  consultant  with  the  army,  but  I  terminated  my 
consultant's  job  with  the  navy,  because  it  wasn't  practical  for  me 
to  go  over  there  any  more. 


Positions  in  Washington,  D.C. 


Gerbode:   I've  held  various  consulting  jobs,  not  only  in  the  two  hospitals, 
but  in  the  central  government  in  Washington  as  well.   I  was  on  the 
National  Research  Council  for  several  years.   I  was  on  the  Surgical 
Studies  Section  of  NIH  for  a  long  time,  and  several  other 
committees  like  that  in  Washington.   So  I  have  a  long  track  record 
of  round  trips  to  Washington,  paid  for  by  the  government. 

Hughes:   Do  you  know  why  those  appointments  came  about? 

Gerbode:   I  guess  they  thought  I  had  a  reputation  for  doing  things  fairly 

and  squarely  and  making  decent  decisions.   I  enjoyed  being  on  those 
committees,  because  I  was  always  with  friends. 

Hughes:   Did  it  tend  to  be  the  leading  people  in  the  field? 

Gerbode:  They  were  all  academic  people.   They  were  professors  of  surgery  or 
associate  professors. 

[interruption] 


151 


Hughes: 


Gerbode: 


Hughes : 
Gerbode: 
Hughes : 

Gerbode: 


Hughes : 


I  was  wondering  what  the  differences,  if  any,  were  between  Letterman 
and  the  naval  hospital? 

They  were  very  much  the  same.   In  fact,  for  a  long  time  there  was 
a  big  discussion  about  whether  they  should  build  a  new  hospital  in 
Oakland  and  a  new  hospital  at  Letterman.   The  programs  were  so 
similar  that  I  was  one  who  advocated  building  one  armed  services 
hospital  instead  of  building  two.   My  friend  Frank  Berry,  who  was 
then  undersecretary  of  health  in  Washington,  was  also  a 
strong  advocate  of  building  one  hospital.   But  one  cannot  get  these 
services  together.   The  one  place  where  they  got  them  together  was 
in  Honolulu,  where  they  built  one  hospital  for  the  army  and  the 
navy  and  the  marine  corps.   But  it  went  down  as  a  very  strong,  big 
pill,  which  nobody  really  liked  to  swallow. 

Too  much  territoriality. 
Yes. 

Was  it  unusual  for  military  hospitals  to  have  such  an  academic 
interest? 

It  was  unusual  before  the  war,  but  after  the  war  the  veterans' 
hospitals  and  the  [military]  service  hospitals  realized  they'd  have 
to  have  training  programs  to  train  specialists  in  general  surgery, 
general  medicine,  and  all  the  other  specialities.   In  order  to  do 
that,  they  had  to  have  some  sort  of  an  academic  program  going,  so 
they  had  to  utilize  the  nearby  medical  schools. 

The  veterans'  hospitals  reorganized  their  entire  approach  by 
putting  the  hospitals  in  charge  of  medical  schools.   The  dean's 
committee  of  the  medical  school  in  that  area  really  ran  the 
professional  aspects  of  the  veterans'  hospitals  and  improved  the 
care  of  the  veterans  enormously  as  a  consequence.   This  is  still  in 
existence.   The  professional  part  of  the  veterans'  hospital  here 
in  San  Francisco  is  really  run  by  the  dean  of  the  University  of 
California.   He  puts  men  over  there  as  consultants,  and  usually 
they're  academic  people.   He  actually  puts  residents  through  there 
from  his  training  program  at  the  county  hospital  [San  Francisco 
General]  and  at  U.C.   So  it's  been  very  good. 

After  the  war,  you  wrote  a  number  of  papers  on  vascular  surgery 
[where]  the  injuries  were  the  result  of  the  war.   Were  those  cases 
done  at  one  of  those  hospitals? 


152 


Gerbode:   Yes,  I  did  quite  a  few,  mainly  at  the  naval  hospital,  because  they 
had  a  whole  batch  of  marines  who  were  shipped  in  there  who  had  been 
badly  shot  up  in  the  Far  East.   So  they  invited  me  over  to  consult 
on  them.   I  helped  them  reestablish  circulation,  mainly  in  legs 
and  arms.   Occasionally  I  would  take  a  foreign  body  out  of  the  chest 
somewhere.   Frank  Spencer  was  over  there  with  me  for  a  little  while, 
before  he  went  to  the  Far  East.  He's  now  professor  of  surgery  at 
New  York  University. 

Hughes:   You  mean  he  was  there  on  a  permanent  basis? 

Gerbode:  No,  he  was  there  to  do  his  military  duty  for  two  years.   In  any 
event,  I  guess  the  army  thought  I'd  contributed  something  to 
developing  their  thoracic  training  program  at  Letterman.   So  a 
number  of  years  later  they  gave  me  a  very  important  civilian  service 
award,  which  is  a  nice  little  medal.   They  had  a  ceremony  when  they 
gave  it  to  me  at  Letterman,  and  they  had  the  army  band  from 
Sacramento  playing  on  the  stage.   At  the  same  time  that  they  gave 
me  the  award,  they  were  giving  the  certificates  of  training  to  their 
residents.   The  band  was  playing  merrily  on,  and  when  my  turn  came 
to  get  this  award  by  the  general,  I  thought  the  music  sounded  rather 
strange  and  semi-familiar.   But  if  you've  ever  heard  an  army  band, 
you  sometimes  have  difficulty  understanding  what  they're  playing, 
[laughter]   I  finally  realized  they  were  playing  "I  Left  My  Heart 
in  San  Francisco."   [laughter]* 


*A  discussion  of  the  peer  review  system  was  moved  to  the  session 
recorded  on  8/26/84. 


153 


V  PRESBYTERIAN  MEDICAL  CENTER,  THE  HEART  RESEARCH  INSTITUTE, 
AND  COMPUTERIZED  PATIENT  MONITORING 


The  Stanford  Medical  School's  Move  to  Palo  Alto,  1959 


Debate  Over  the  Move 


Hughes:   Do  you  want  to  move  on  to  the  move  to  Stanford? 

Gerbode:   Yes.   As  soon  as  I  came  up  [to  San  Francisco]  from  Palo  Alto  and 
medical  school,  which  was  1932,  I  began  to  feel  that  there  were 
people  around  who  wanted  to  move  that  school  to  Palo  Alto.   The 
faculty  in  San  Francisco  mainly  wanted  to  rebuild  the  hospital  and 
the  medical  school  up  here.   They  liked  San  Francisco.   They  had  a 
very  good  teaching  program  at  the  county  hospital,  half  of  which  they 
ran.   They  felt  that  it  was  better  for  a  medical  student  to  grow 
up  in  a  relatively  big  city,  and  see  all  the  various  aspects  of 
medicine  than  to  be  in  a  small  town  which  is  not  representing  a 
cross-section  of  what  the  world  is  about. 

However,  as  time  went  on,  we  had  a  president  [of  Stanford]  by 
the  name  of  Don  Tressider,  who  was  a  member  of  a  family  that  had 
been  with  Yosemite  for  a  long  time,  and  he  was  very  interested  in 
rebuilding  the  school  in  San  Francisco.   He  was  a  very  good  friend 
of  the  dean,  Yank  [Loren  R. ]  Chandler.   As  long  as  Tressider  was 
president  of  the  university,  the  thought  of  rebuilding  the  school 
was  predominant.   But  unfortunately  he  had  a  coronary  and  died  on  the 
East  Coast. 

Then  Wally  Sterling  was  made  president.   Wally  was  very  much 
influenced  by  some  of  the  people  in  Palo  Alto,  particularly  some 
of  those  who  were  connected  with  the  Palo  Alto  Clinic.   Although  he 
is  a  very  fine  man,  and  I've  liked  him,  and  I  think  was  a  great 


154 


Gerbode:   president  of  Stanford,  I  think  he  had  very  strange  thoughts  about 
doctors  and  medical  schools.   Some  of  it  may  have  come  from  the 
fact  that  he  came  from  a  minister's  family.   But  I  think  he  really 
has  never  been  exposed  to  what  went  into  medical  schools.  However, 
as  time  went  on,  his  thoughts  predominated,  and  it  was  decided  to 
move  the  school  to  Palo  Alto. 

Hughes:   What  was  he  afraid  of? 

Gerbode:  He  wanted  to  have  everything  on  one  campus,  and  there's  certainly 
justification  for  it. 


Decision  to  Stay  in  San  Francisco 


Gerbode:   So  at  this  time  [1959]  there  were  forces  which  tried  very  hard  to 
get  me  to  move  to  Palo  Alto.   Various  committees  approached  me  to 
ask  if  I  would  go  down  and  be  chairman  of  the  department  of  surgery. 
Another  committee  asked  me,  if  you  don't  want  to  be  chairman, 
would  you  go  down  and  be  dean  of  the  medical  school?  At  the  same 
time,  the  University  of  California,  thinking  that  maybe  the  school 
was  going  to  move,  thought  they  could  capture  some  of  the  faculty 
of  the  old  Stanford  school.   So  two  committees  came  to  see  me  and 
asked  me  if  I  would  start  a  heart  program  at  U.C.   They  had  one 
going  already,  but  they  weren't  particularly  happy  with  it. 

Hughes:   This  was  the  late  '50s? 

Gerbode:  Yes,  1958  or  '59.   I  realized  that  if  I  moved  to  Palo  Alto,  it  would 
mean  that  I  would  go  back  to  living  in  a  very  controlled  environment, 
and  so  would  my  wife.  She  was  at  that  time,  in  the  '50s,  getting  to 
be  known  in  San  Francisco  in  various  organizations  and  enjoying  it, 
too.   She  liked  working  with  things  in  the  City.   I'm  quite  sure  that 
had  I  decided  to  go  to  Palo  Alto,  I  would  have  had  to  go  down  there 
alone,  [laughter]  which  I  was  not  too  keen  to  dc  anyway. 

The  other  thing  about  moving  to  Palo  Alto  is  that  I  really  don't 
like  the  small-town  concept  of  a  university  [community].  A  university 
community  [is]  like  a  small  town.   Everybody  knows  what  you're  doing. 
When  you  buy  a  new  car,  it's  a  subject  of  general  conversation.   If 
your  house  is  bigger  than  somebody  else's,  there  is  a  great  deal  of 
discussion  about  that.   If  you  give  a  party,  everybody  knows  it.   It's 
Main  Street  all  over.   I  don't  like  that  part  of  it.   Now,  some 
people  can  live  in  this  environment  and  thoroughly  enjoy  it,  but  I 
couldn't. 


155 


Gerbode:   The  other  reason  I  didn't  want  to  go  was  that  I  felt  that  in 

building  a  new  medical  school  at  Stanford,  there  was  going  to  be 
an  awful  lot  of  administrative  planning,  a  lot  of  committee  work. 
This  would  mean  that  if  I  had  gone,  I  would  be  in  committees  all 
the  time  and  not  trying  to  develop  heart  surgery.   I  knew  the  history 
of  other  medical  schools  that  had  moved.   It  usually  took  one  whole 
generation  before  all  the  problems  were  sorted  out.*   So  I  had  to 
decide  whether  or  not  I  wanted  to  become  the  professor  or  develop 
heart  surgery.   I  decided  that  I  wanted  to  stay  in  San  Francisco, 
and  my  wife  didn't  want  to  go  to  Palo  Alto.   So  that  was  the 
decision. 


Attempts  to  Retain  a  Connection  With  Stanford 


Gerbode: 


We  tried  desperately  to  get  Stanford  to  keep  a  connection  with  us  up 
here,  retain  an  academic  program  as  a  post  graduate  medical  school, 
or  something.  But  Dr.  Sterling  wanted  to  cut  it  off  completely.   He 
wanted  a  complete  amputation. 

I  can  remember  the  discussions  with  some  of  the  board  members 
of  the  university,  notably  Dave  Packard,  who  was  chairman  of  the 
board  of  trustees.   He  obviously  was  told,  "Don't  let  those 
San  Francisco  people  have  anything,  because  we  need  all  the  patients. 
We  need  everything  we  can  get  down  here  to  get  this  school  going." 
This  was  a  different  point  of  view  than  what  they  were  saying.   They 
were  saying  that  there  were  plenty  of  patients  in  the  area  around 
San  Jose  and  Palo  Alto,  and  they  had  big  charts  to  show  this.   They 
also  had  charts  showing  the  population  growth,  so  they  needn't 
have  feared  competition  up  here  at  all.   However,  at  meetings,  which 
were  being  held  mainly  at  the  Fireman's  Fund  Insurance  Company,  Dave 
Packard's  theme  song  was  to  bury  the  old  medical  school.   They  even 
wanted  to  close  the  outpatient  clinics,  thinking  that  if  we  retained 
an  outpatient  clinic,  that  this  would  take  patients  away  from  Palo 
Alto.   Obviously,  most  of  the  patients  didn't  come  from  Palo  Alto. 
A  great  many  lower  income  residents  came  from  nearby.   This  was, 
again,  a  foolish  position  to  take.   They  said  [they  were]  going  to 
lose  money  to  keep  those  outpatient  clinics  going.   This  was  then 
called  San  Francisco  Stanford  Hospital.   So  then  I  said  to  some  of 
my  colleagues,  "Suppose  we  get  a  group  of  people  together  and  say 
we  will  underwrite  the  expense  of  keeping  the  outpatient  clinics 
going?"   So  we  got  forty  doctors  to  each  pledge  a  thousand  dollars 
if  necessary  to  keep  the  outpatient  clinics  open.   With  this  threat, 


*The  two  foregoing  sentences  were  added  from  the  session  recorded 
on  8/16/83. 


156 


Gerbode:   Stanford  couldn't  very  well  close  them.   [laughs]   So  they  kept 

them  as  they  were,  and  nobody  lost  any  money,  and  the  clinics  went 
on.   But  we  had  to  play  a  strong  game  with  them  to  get  them  to  do 
this. 

However,  regardless  of  what  I  did  or  anybody  else  did,  they 
would  not  retain  any  academic  connection  with  San  Francisco.   I  made 
several  trips  down  to  talk  to  Wally  Sterling  about  it.   They  were 
very  much  influenced  by  Russ  Lee,  who  was  then  running  the  Palo 
Alto  Clinic.  He  had  the  ear  of  the  president  and  the  people  on  the 
campus.   They  listened  to  him  more  than  they  listened  to  anybody 
else.   Russ  Lee's  primary  mission  in  life  was  to  make  the  Palo  Alto 
Clinic  a  bigger  and  better  place  on  the  peninsula. 

To  show  you  how  Russ  Lee  operated:   [He],  some  of  the  faculty 
members  from  San  Francisco  and  some  of  the  ones  who  were  going  to 
be  in  Palo  Alto  were  having  dinner  together.   Russ  Lee  said  to  me, 
"Frank,  I  think  the  best  thing  to  do  when  the  medical  school  moves 
to  Stanford  is  for  the  Palo  Alto  Clinic  to  take  all  the  private 
patients,  and  we'll  give  you  plenty  of  teaching  material.   We'll 
give  you  all  the  teaching  material  you  want  in  exchange  for  running 
the  private  patients."  Well...  As  if  nobody  could  see  through 
this  suggestion.   It  was  obvious  that  this  was  the  way  he  was  working 
and  thinking.  He  was  a  very  smart,  clever  man  in  this  respect. 
Unfortunately,  I  think  some  of  the  people  in  Palo  Alto  listened  to 
him  rather  seriously. 

In  any  event,  since  the  decision  was  made  to  move,  then  we  had 
to  try  to  figure  out  what  to  do  with  what  was  left.   The  San  Francisco 
Stanford  Hospital  was  really  in  terrible  shape.   The  old  medical 
school  was  really  in  worse  shape. 

Hughes:   Excuse  me,  but  the  preclinical  years  had  always  been  at  Stanford? 

Gerbode:  They  had  the  first  year  and  the  first  quarter  of  the  second  year 
at  Stanford.  So  the  rest,  two  and  three-quarters  years,  were  up 
here. 

Hughes:   And  that  was  all  going  to  change. 

Gerbode:  The  whole  thing  went  down  there.   Simple  things  like  putting  two 

automatic  elevators  in  the  old  Stanford  Hospital  was  a  huge  hurdle. 
But  we  finally  got  Stanford  to  underwrite  these  two  automatic 
elevators.   But  things  were  financially  in  very  bad  shape. 

Hughes:   They  just  weren't  willing  to  pay  for  anything. 


157 


Gerbode:   They  weren't  willing  to  do  anything . 

Hughes:   Were  they  just  hoping  that  the  place  would  fold  up? 

Gerbode:   Oh,  yes.   They  wanted  it  to  fold  up.   In  fact,  a  lot  of  the  doctors 
who  had  been  sending  patients  into  the  old  Stanford  Hospital  thought 
it  was  folded  up.   But  anyway,  the  thing  that  really  saved  it  was  the 
fact  that  heart  surgery  was  really  kind  of  exploding,  and  we  began  to 
fill  up  the  place  with  heart  patients,  because  we  were  the  only  one 
on  the  West  Coast  doing  open  heart  surgery.   All  the  old  channels 
opened  up,  and  they  sent  all  the  patients  to  us.   This  wasn't 
only  from  the  Bay  Area,  but  also  from  Alaska  and  Oregon  and  Nevada. 

Hughes:   The  whole  West. 

Gerbode:   The  whole  West,  really.   Some  of  the  patients  even  came  from 

Los  Angeles.   Of  course,  this  also  made  Stanford  want  us  to  move 

to  Palo  Alto  even  more.   Anyway,  the  lady  that  runs  the  cashier's 

desk  [at  Presbyterian  Hospital],  who's  still  over  there  as  a  matter 

of  fact,  said,  "Please,  Dr.  Gerbode,  don't  leave  town."  [laughter] 

The  heart  surgery  and  all  the  cardiology  connected  with  it  was 
really  keeping  the  place  alive. 


Staff  Decisions  about  the  Move 


Hughes:   What  about  the  staff,  now? 

Gerbode:   A  handful  of  the  senior,  high-level  faculty  moved  to  Palo  Alto. 

Hughes:   They  were  attracted  by  good  positions  there? 

Gerbode:   Good  positions.   Some  of  them  were  promoted.   They  were  made 

professors  or  associate  professors,  and  they  automatically  got 
tenure  then,  which  appealed  to  them  a  good  deal. 

Hughes:    It  would  have  been  possible  here,  too. 

Gerbode:   No,  we  had  no  way  of  giving  them  tenure  up  here.   The  bulk  of  the 

clinical  faculty  who  was  not  full-time  stayed  here  in  San  Francisco, 
because  they  had  practices  here  and  didn't  want  to  move.   Some  of 
the  full-time  faculty  decided  to  stay  as  well. 

Hughes:   Who  was  there  at  that  time  in  cardiovascular  surgery? 


158 


Gerbode:   Norm  Shumway  had  moved  out  from  Minneapolis.   He  came  out  really 
to  try  to  get  a  job  somewhere,  and  there  wasn't  anything  open. 
So  he  started  doing  experiments  in  our  old  dog  lab. 

Hughes:   Right  about  this  time. 

Gerbode:  Nineteen  fifty-five  or  '56,  somewhere  in  there. 


Gerbode:   I  was  at  the  same  time  developing  heart-lung  machines.   So  the 

old  lab  was  pretty  busy,  busier  than  almost  any  other  place  in  the 
old  hospital. 

Hughes:   Was  there  anybody  else? 

Gerbode:  Yes,  there  were  some  others  who  were  trying  to  get  into  the  heart 
picture  at  the  time.   Jack  Connolly  was  doing  some  experiments 
and  trying  to  get  into  the  picture. 

Hughes:   Did  he  succeed? 

Gerbode:   He  didn't  really  get  fully  into  the  heart  surgery  business.   He 

moved  down  with  the  group  to  Palo  Alto  for  a  short  while,  and  then 
became  professor  of  surgery  at  U.C.  Irvine. 

Hughes:   Was  there  any  feeling  of  betrayal  when  people  left? 

Gerbode:  No,  there  wasn't.  We  just  felt  that  they  should  go  where  they 
wanted  to  go. 

Hughes:   What  about  your  frame  of  mind  with  the  threat  of  the  whole 
institution  folding  under  you? 

Gerbode:   I  had  my  ego  to  cope  with,  because  I  had  to  make  a  decision  of 
whether  to  be  the  professor  and  ride  the  tide  or  to  fight  a 
different  kind  of  a  battle  up  here  and  stay.   It  took  me  several 
months  to  really  sort  this  out  and  decide  to  stay.   But  when  I 
thought  about  my  family  and  wife  and  the  life  in  San  Francisco,  this 
made  the  decision  quite  a  bit  easier. 

Hughes:   Did  you  ever  have  doubts  about  it? 
Gerbode :  Once  I  made  up  my  mind ,  that  was  it . 

Hughes:   You  didn't  have  any  doubts  about  the  institution  itself  being 
viable? 


159 


Gerbode:   I  had  doubts,  but  I  felt  that,  knowing  the  history  of  the  place — 
You  see,  it  was  the  first  medical  school  in  the  West,  and  it  was 
the  best  hospital  in  the  West  for  many,  many  years,  even  before 
Stanford  took  it  over.   It  had  a  beautiful  location  in  San  Francisco. 
The  property  was  ideal  for  a  hospital  and  for  a  teaching  hospital, 
because  they  were  right  next  to  the  people  on  one  side  that  could 
pay  for  services,  and  on  the  other  side,  the  people  who  needed  to 
have  services  and  couldn't  pay  for  them.   [Elias  Samuel]  Cooper 
and  [Levi  Cooper]  Lane,  who  started  this  whole  thing,  realized 
this.    So  they  had  both  the  outpatient  services  and  the  paying 
beds  filled.   An  ideal  situation. 

But  in  any  event,  I  really  believe  that  heart  surgery  saved 
the  place.   That  plus  the  fact  that  we  really  kept  telling  people, 
"We  aren't  dead.   The  place  is  still  open,  and  we're  going  to  go 
somewhere. " 


The  Institutes  of  Medical  Sciences* 


Gerbode:   Then  the  question  came  up,  what  to  do  about  research?  With  Stanford 
pulling  out  and  not  being  willing  to  sponsor  anything  in  research 
or  teaching,  I  decided  that  the  hospital  really  couldn't  have 
a  very  good  research  program  at  that  time,  because  the  departmental 
chiefs  were  not  particularly  interested  in  research,  and  everybody 
was  thinking  more  than  anything  else  about  how  to  save  the  hospital, 
which  was  justified. 

So  I  decided  that  I'd  get  together  with  the  people  who  were 
going  to  stay  who  were  former  full-time  teachers  in  the  medical 
school  and  put  together  some  other  kind  of  organization  to  keep  the 
research  going.   At  that  time,  we  had  about  two  hundred  and  fifty 
thousand  dollars  of  grants  with  NIH  and  the  Cancer  Society  and  a 
couple  of  other  small  organizations,  like  the  Heart  Association.   I 
asked  them  if  we  [started]  another  [research]  organization  in 
San  Francisco,  would  they  transfer  the  money  to  this  organization. 
I  also  went  to  Stanford  and  asked,  since  the  money  wasn't  going 
to  go  to  Palo  Alto,  would  they  mind  letting  us  move  it  into 
another  organization.   They  all  agreed. 


*See  the  sessions  recorded  on  5/15/84,  pp.  380-387. 


160 


Foundation 


Gerbode:   So  then  I  had  my  cousin,  Bud  Chandler,  put  together  a  nonprofit 
research  organization  called  the  Institutes  of  Medical  Sciences. 
Jack  Osborn,  Henry  Newman,  Arthur  Selzer  and  Fred  Merrill  joined 
in  this  basic  thinking  with  me  and  were  the  original  founders. 
Mrs.  Harley  Stevens,  an  old  friend,  was  also  one  of  the  original 
founders. 

Hughes:   Was  it  your  administrative  abilities  coming  to  the  fore  again?  Why 
were  you  spearheading  this? 

Gerbode:   I  don't  know.   I  suppose  I've  always  had  a  certain  amount  of 
momentum,  and  it  was  the  momentum  that  made  me  do  it  again. 

Hughes:    [laughs]  That  sounds  like  an  understatement. 

Gerbode:   I  realized  that  I  had  to  do  something  to  form  the  basis  for  a 

research  organization.   I  went  back  to  the  Rockefeller  Institute 
in  New  York  and  sat  down  with  the  director  and  asked  him  how  it  all 
started  back  there.   I  said,  "I'd  like  to  see  your  bylaws  and 
your  original  charter."  He  said,  "It  was  very  simple.  We  had  very 
few  rules  and  regulations,  and  we  simply  set  up  an  organization 
where  research  people  could  work  freely  without  being  interfered 
with,  and  kept  the  environment  simple,  but  good  for  them."  This  is 
what  I  more  or  less  had  in  mind,  that  we  would  have  a  simple 
organization  where  there  weren't  many  rules  and  where  people  who 
wanted  to  do  research,  could  do  research  without  interference. 
The  organization  was  to  be  simply  there  to  help  them,  not  to 
regulate  them.   Perhaps  the  old  Stanford  expression  "Die  Luft  der 
Freiheit  weiht,"  the  winds  of  freedom  blow,  was  in  the  back  of  my 
mind  to  a  certain  extent. 

Anyway,  we  transferred  the  grants  to  this  little  organization. 
We  had  one  lady  running  the  administrative  part.   She  did  everything. 
She  established  the  first  payroll  and  the  first  everything  that  was 
necessary,  in  one  little  room.  Now  we  have  a  huge  administrative 
staff  in  this  organization.   Some  people  think  it's  too  big. 

Hughes:   Did  people  stay  pretty  much  on  the  same  salary  when  they  moved  from 
Stanford  to  the  institutes? 

Gerbode:   Yes,  they  did. 

Hughes:   But  there  was  no  longer  any  academic  connection? 


161 


Gerbode:   No  academic  connection  at  all.   Some  people  had  academic  appointments 
with  the  University  of  California,  and  some  of  them  retained 
clinical  appointments  with  Stanford.   I  was  made  a  clincial 
professor  at  Stanford  and  a  clinical  professor  at  U.C. ,  which  meant 
that  I  would  teach  part-time  or  be  called  upon  to  do  teaching, 
research,  or  administration,  when  necessary. 

Hughes:    I  know  that  the  clinical  appointment  at  Stanford  had  been  long 
standing,  but  do  you  remember  when  the  appointment  at  U.C.  occurred? 

Gerbode:   When  I  decided  not  to  move  to  Palo  Alto — at  that  time  I  was  an 

associate  professor — the  dean,  who  was  Windsor  Cutting,  promoted  me 
to  clinical  professor.  This  was  about  the  same  time  that  U.C.  made 
me  a  clinical  professor  as  well.* 

Hughes:   Was  there  any  particular  tie-in  with  the  move? 

Gerbode:   I  guess  U.C.  wanted  me  to  be  [part  of  the  U.C.  program].   I  was 

not  the  only  one  who  was  brought  into  the  U.C.  program  one  way  or 
the  other.   We  had  a  pretty  good  thing  going  [cardiovascular 
surgery],  better  than  theirs,  and  so  they  wanted  to  have  us 
associated  with  them. 

.Since  the  heart  surgery  was  going  so  well,  and  since  the 
people  in  Washington  were  really  quite  sentimentally  connected  with 
some  of  the  people  who  didn't  want  to  go  down  there,  they  were 
anxious  to  help  us.   There  were  people  in  Washington  who  felt  that 
it  was  a  mistake  to  move  the  school  back  to  Palo  Alto ,  that  it  would 
have  been  better  to  leave  it  in  San  Francisco.   They  cited  North 
western,  New  York  University,  Harvard  and  Hopkins  as  examples  of 
medical  schools  which  are  great  and  which  had  stayed  in  the  bigger 
city.   So  they  were  rather  favorably  inclined  toward  helping  us  one 
way  or  the  other.   We  had  such  a  vigorous  program  going  in  cardiac 
surgery.   We  were  writing  papers,  too,  and  developing  research  to 
back  up  the  programs. 


The  NIH  Program  Project  Grant 


Gerbode:   So  I  applied  to  NIH  for  a  huge  grant,  called  a  program  project  grant. 
The  administrator  in  Washington  of  the  Heart  Research  Institute 
of  NIH  came  out,  and  we  spent  a  couple  of  days  talking  about  it.   I 


*According  to  Dr.  Gerbode 's  curriculum  vitae,  he  became  clinical 
professor  of  surgery  at  UCSF  in  1964.  The  appointment  ended  in  1976. 


162 


Gerbode:   said,  "How  much  do  you  think  I  should  apply  for?"  He  said,  "You 

apply  for  whatever  you  think  you  need,  and  the  peer  committee  will 
decide  whether  or  not  you  get  anything. 

So  I  applied  for  a  million  dollars  a  year  for  all  sorts  of 
things. 

Hughes:   That  was  an  enormous  sum  in  those  days,  wasn't  it? 

Gerbode:   It  was.   The  committee  came  out,  and  looked  us  over.   We  had  a 

couple  of  meetings  in  Washington.   Finally  it  was  all  done;  they 
gave  me  something  like  four  hundred  and  fifty  thousand  dollars  a 
year  for  five  years.   After  this  other  grants  were  given  for 
another  five  years. 

Hughes:   Were  you  satisfied  with  that? 

Gerbode:   Oh,  yes.   It  was  that  big  grant  which  put  together  the  heart  unit 
here  in  San  Francisco. 

Hughes:   What  were  the  stipulations? 

Gerbode:   I  had  a  separate  training  program,  too,  which  [NIH]  gave  me,  so  I 
could  train  two  fellows  in  cardiac  surgery  a  year.   That  was  paid 
for  out  of  [an  NIH  training  grant].   The  money  entitled  me  to  buy 
equipment,  to  do  research  with  equipment,  to  pay  for  dieners 
engaged  in  research  and  some  salaries  for  research  people — not 
for  me  or  for  any  of  the  professional  people. 

Hughes:   That  was  coming  from  the  Institute? 

Gerbode:   I  never  took  a  salary  from  anybody.   I  made  enough  money  out  of 

operating.   In  fact,  over  the  years,  I  put  more  money  back  into  the 
heart  program  than  I  ever  took  home.   I  made  contributions  to  pay 
for  personnel,  equipment  or  travel — whatever. 

Hughes:   This  was  through  the  Gerbode  Foundation? 


163 


The  Heart  Research  Institute  Fellowship  Program  in 
Cardiovascular  Surgery* 


Gerbode:   No,  this  was  direct  contribution  from  my  practice.   We  had  some 
money  for  training  from  Washington,  and  I  got  Mrs.  Ed  Heller  of 
San  Francisco  to  give  me  another  training  fellowship  for  about 
three  years.   So  I  began  to  bring  fellows  in  to  train  in  cardiac 
surgery.   I  needed  them  anyway,  because  we  didn't  have  any 
residents.   The  residency  program  [had]  moved  to  Palo  Alto.   We 
had  a  few  interns,  but  that's  all. 

Hughes:   How  did  you  select  the  fellows? 

Gerbode:   A  lot  of  people  wanted  to  come  and  work  with  us,  because  there 
was  a  lot  of  heart  surgery  [and]  research  going  on,  and  it  was 
one  of  the  most  active  places  in  the  country,  both  in  the  laboratory 
and  clinically.   So  I  had  applicants  from  a  lot  of  places,  and  I 
decided  that  I  would  choose  the  best  men  every  year  regardless  of 
where  they  came  from.   This  was  quite  different  from  the  attitude 
of  many  other  places,  which  felt  obliged  to  take  only  Americans 
in  their  training  programs.   But  I  felt  that  cardiac  surgery  was  a 
world  enterprise,  and  that  all  countries  needed  to  do  it,  and  they 
needed  young  men  to  push  it  forward.   So  I  took  people  from  any 
country.   If  the  candidate  was  better  than  anybody  else  I  had 
locally,  I  would  take  him.  As  a  consequence,  among  the  very  first 
were  the  English.   I  eventually  had  twelve  men  from  the  U.K.  whom 
I  had  trained. 

Hughes:   Each  of  whom  stayed  for  a  year? 

Gerbode:   One  to  two  years,  sometimes  even  three.   I  gave  them  a  lot  to  do. 
They  didn't  really  do  all  of  heart  surgery  when  they  were  in 
training,  but  they  did  parts  of  every  operation.   Whatever  I  felt 
they  could  safely  do,  I  let  them  do.   I  thoroughly  enjoyed  this 
part  of  my  career.   I  just  loved  working  with  these  young  men, 
because  they  were  all  bright  and  very  able,  and  they  had  a  place 
to  go.   That  was  one  other  stipulation  I  made,  that  I  wouldn't 
take  them  unless  their  institution  would  take  them  back  in  the 
field  [of  cardiovascular  surgery] .   So  that  meant  that  a  professor 
would  send  his  brightest  man  over,  or  the  man  he  was  going  to 
designate  to  carry  on  with  the  work  when  he  came  home. 


*Some  of  the  fellows  participating  in  the  program  are  discussed 
on  pp.  400-407. 


164 


Gerbode:  Also,  the  American  Association  for  Thoracic  Surgery  had  an  Evarts 
Graham  Traveling  Fellowship.   They  appointed  [a  fellow]  every  year. 
Once  he  was  given  the  traveling  fellowship,  he  could  go  anywhere 
he  wanted.   I  was  lucky  to  get  four  of  these  Evarts  Graham  fellows, 
and  they  were  sponsored  by  their  own  universities  or  groups  at 
home,  so  they  really  all  had  a  good  place  to  go  back  to. 

Hughes:   I  would  think  not  only  were  you  helping  the  individual,  but  you 

were  certainly  giving  an  impetus  to  cardiac  surgery  in  each  one  of 
those  institutions. 

Gerbode:  Yes,  it  helped,  because  once  these  fellows  came  over  here  and  had 
a  year  or  two,  when  they  went  back,  they  had  a  story  to  tell,  and 
people  listened  to  them.   So  they  had  to  give  them  equipment;  they 
had  to  help  them  get  started.   It  was  great  leverage. 

Hughes:   Has  [the  Heart  Research  Institute  fellows]  program  been  discontinued? 

Gerbode:  Yes,  it  has.   It  was  discontinued  I  guess  for  two  reasons.   One  is 
that  I  was  no  longer  running  the  department  and  the  others  in  the 
department  were  not  as  interested  in  teaching.   But  the  other 
reason  is  that  the  government  turned  off  the  foreign  fellows  program. 
There  was  much  pressure  on  Uncle  Sam  to  keep  the  flood  of  immigrants 
in  the  professional  sciences  out  of  this  country.  Many  of  them  came 
from  underprivileged  countries  and  then  never  went  back.   It  takes 
an  awful  lot  of  money  to  turn  out  a  doctor  in  a  third-world  country, 
and  then  having  spent  all  this  money  on  him  and  sent  him  over  here 
for  further  training,  to  not  have  him  ever  come  back  is  not  very 
good. 

Hughes:   I  guess  it  would  have  been  an  abridgement  of  individual  freedom  to 
stipulate  that  in  order  to  participate  in  the  program  here,  the 
individual  must  return  to  his  native  country. 

Gerbode:   I  tried  to  always  pick  my  fellows  so  that  it  would  be  a  requirement 
that  they  would  have  to  [return  to  their  country] .   I  think  all 
but  two  or  three  have  gone  back  to  their  country  to  continue  their 
work.   There  are  two  Indians  who  didn't  go  back.  All  the  Germans 
went  back;  all  the  English  went  back  except  one.* 

In  the  end  I  had  over  eighty  men  go  through  the  unit.  They 
weren't  all  real  fellows.  Some  of  them  were  residents.  I  think 
there  were  eighty-eight  fellows.  Out  of  the  eighty-eight — I've  kept 


*Some  of  the  foregoing  material  was  moved  from  the  session  recorded 
on  8/26/83. 


165 


Gerbode:   track  of  them  pretty  well — sixty-three  currently  now  are  either 

chiefs  of  service  or  associate  chiefs  of  service  or  professors  of 
surgery.  There  are  only  two  or  three  that  went  into  pure  private 
practice.  And  they're  scattered  all  over  the  world. 

Hughes:   Did  the  fellows  not  only  operate,  but  also  do  research  as  well? 

Gerbode:   It  wasn't  a  requirement  that  they  do  research,  but  everyone  had  a 
research  program,  either  clinical  or  experimental.   Most  of  them 
did  experimental  surgery. 

Hughes:    I  imagine  that  in  most  cases  that  was  unusual  in  their  countries 
of  origin. 

Gerbode:   Yes.   Many  of  them  had  never  done  any  experimental  surgery  at  all. 
When  they  went  back,  they  helped  their  institutions  set  up 
experimental  laboratories,  and  that  pushed  their  programs  forward 
quite  a  good  deal. 

The  great  thing  about  having  these  fellows  all  over  the  world 
is  wherever  I  go  now,  there's  somebody  there  who's  been  in  the 
institute.   It's  like  being  a  member  of  the  family.   For  example, 
in  India  there  are  four  outstanding  heart  surgeons  who  may  meet 
you  at  the  airport.   There  are  four  in  Australia,  all  doing  very 
well.   Twelve  in  the  U.K.   I  think  three  of  them  in  Germany.   Two 
of  them  in  Norway.   One  in  Sweden.   He's  going  to  be  made  professor 
of  surgery  in  one  of  the  biggest  and  oldest  medical  schools  this 
year.   Halsted,  who  was  the  so-called  father  of  American  surgery, 
the  professor  of  surgery  at  Hopkins,  was  quoted  to  have  said  that 
if  a  professor  or  a  chief  trains  six  men  in  his  lifetime,  he  will 
have  accomplished  what  he  should  have. 

Hughes:   Well,  you  did  much  more  than  that! 

Gerbode:   Anyway,  it  was  really  great  fun,  and  also  my  wife  enjoyed  having 
people  from  outside  of  the  United  States  in  my  home.   We'd  have 
little  after-dinner  discussions  once  in  a  while  at  home.   My  daughter 
[Maryanna],  who  was  a  little  girl  then,  used  to  like  it  because  we 
always  had  donuts,  and  she  loved  to  come  down  during  the  party 
and  eat  a  donut. 

Hughes:    In  most  cases,  did  they  go  home  to  find  that  their  chiefs  were 
receptive  to  the  changes.... 

Gerbode:   In  most  cases  they  were.   But  they  found  that  it  was  very  difficult 
to  get  things  done  in  many  places. 


166 


Hughes:   I  imagine  equipment  would  be  a  great  problem. 

Gerbode:   Yes,  and  the  politics  really  floored  them  in  many  cases.   For 
example,  one  of  my  fellows  from  Denmark  went  back,  and  he  was 
persumably  to  be  given  a  job  to  get  heart  surgery  going  better 
than  it  was.  But  the  politics  were  so  terrible  in  the  hospital,  he 
just  was  very  frustrated.   In  fact,  I  saw  him  last  year,  and  he 
said  although  he's  gotten  it  going,  there's  still  jealousy  and 
pulling  and  tugging.   He  said,  "You  taught  me  how  to  do  the  work, 
but  you  didn't  tell  me  how  to  do  the  politics."   [laughter]   I  said, 
"Well,  that's  something  you  just  have  to  learn  as  you  go  along. 
All  life  is  politics."  All  life  is  politics,  and  all  life  is 
compromise. 

It  is  true  that  the  political  aspects  of  anything  like  this 
are  really  horrendous  at  times.  In  fact,  the  politics  here  were 
very  difficult.  It  was  very  difficult  for  the  doctors  to  accept 
the  fact  that  we  wanted  to  build  a  research  building. 

Hughes:   You  mean  the  doctors  that  were  part  of  this  complex? 

Gerbode:  The  doctors  who  didn't  go  to  Palo  Alto.  They  wanted  a  hospital, 
and  they  couldn't  understand  why  we  would  spend  a  hundred  and 
fifty  thousand  dollars  to  build  a  research  building.   I  said,  "You 
can't  build  a  hospital  for  that  amount  of  money.   You  don't  even  get 
started  with  a  hundred  and  fifty  or  two  hundred  thousand  dollars, 
liicle  Sam  is  giving  you  the  research  building." 


Presbyterian  Hospital 


Gerbode:   It  was  hard  for  them  to  understand  that.   They  felt  that  everybody 
should  be  doing  one  thing,  getting  a  new  hospital.  Well,  we 
needed  to  do  that,  too,  and  finally  we  did  it.   But  that's  another 
story,  how  we  got  it  done. 

Hughes:   Isn't  this  the  time  to  talk  about  it? 


167 


The  Presbyterian  Church 


Gerbode:   Yes,  I  think  probably.   [We]  got  a  new  board  of  trustees  when 
Stanford  finally  decided  to  transfer  the  property  to  the 
Presbyterian  Church.   The  presbytery  of  San  Francisco  said  they'd 
be  willing  to  take  on  the  hospital.   Traditionally  in  the 
Presbyterian  Church  they  have  good  hospitals  in  a  lot  of  parts  of 
the  country  that  are  very  successful.   There's  one  in  New  York. 
They'd  just  finished  another  one  in  southern  California  at  that 
time.   It  was  very  good  for  their  church,  I  guess,  to  be  associated 
with  a  good  hospital.   They  changed  the  name  from  San  Francisco 
Stanford  Hospital  to  Presbyterian  Hospital. 

Hughes:   What  does  that  mean,  when  the  church  takes  over? 

Gerbode:   Well,  it  didn't  mean  as  much  as  people  thought.   They  thought  that 
the  church  then  would  pour  money  into  making  a  new  hospital.   But 
the  church  poured  very  little  money  in.   As  somebody  said,  the 
Presbyterians  are  mainly  Scotch.   They're  very  good  at  collecting 
money,  but  not  very  good  at  giving  it  away.   [laughter]   There 
were  various  committees  about  the  old  hospital,  about  what  we  could 
do  to  rebuild  it.   They  had  several  planning  groups  come  in  and  do 
things.   But  it  was  obvious  you  needed  to  get  another  group  of 
people  with  some  money  or  influence  to  make  the  thing  go. 


St.  Joseph's  Hospital 


Gerbode:   So  at  that  time,  the  nuns  at  St.  Joseph's  Hospital  here  in 

San  Francisco  said  that  they  looked  favorably  upon  joining  with  us. 
They  had  some  money  to  put  into  the  program.   This  was  fine,  in 
the  beginning,  but  then  as  time  went  on,  the  trustees  realized  that 
they  weren't  going  to  put  in  very  much.   They  wanted  to  dominate 
the  board  of  trustees  of  the  newly  formed  hospital  group.   All  they 
really  were  basically  interested  in  was  to  get  this  hospital  into 
their  domain. 

Hughes:   Did  they  have  access  to  a  hospital? 

Gerbode:   Yes,  they  had  St.  Joseph's  Hospital,  and  they  were  members  of  a 
national  group  in  the  Catholic  Church.   It  was  apparent  that  the 
national  group  was  not  going  to  put  up  any  money  either.   Although 
the  local  people  thought  they  would,  they  didn't. 


168 


Hughes:   Why  were  they  interested  in  yet  another  hospital? 

Gerbode:  Well,  prestige,  with  a  great  history,  you  know.   Their  hospital, 
St.  Joseph's,  really  existed  because  of  one  specialty,  orthopedic 
surgery.   That's  all.   The  rest  was  really  nothing. 

Hughes:   What  about  the  Presbyterians?  Was  it  a  similar  motivation? 

Gerbode:  We  had  the  remnants  of  everything  here,  a  little  bit  of  everything 
was  still  hanging  around,  left  over.   So  anyway,  it  was  really  a 
dilemma  to  know  what  to  do. 


The  University  of  the  Pacific 


Gerbode:   I  was  up  at  the  Bohemian  Grove  that  summer  just  at  this  critical 

time,  and  I  ran  into  Bob  Burns,  who  was  president  of  the  University 
of  the  Pacific.   I  sat  down  with  him  on  a  log,  and  I  said,  "Bob, 
I  think  with  your  university  and  a  little  luck  and  a  little 
enterprise,  we  could  start  another  medical  school  under  the  University 
of  the  Pacific.   But  you've  got  to  get  that  hospital  straightened 
out .   It  has  promise  if  you  want  to  do  it . " 

He  said,  "I'll  go  talk  to  Fred  Merrill  right  now." 

So  we  walked  over  and  talked  to  Fred  Merrill,  who  was  then 
chairman  of  the  board.   Bob  said,  "I'll  see  if  I  can  work  something 
out."  He  really  went  to  work  on  it.  He  really  thought  that  we 
could  put  together  a  different  kind  of  medical  school  under  the 
University  of  the  Pacific. 

With  that,  we  decided  that  we  would  really  have  to  get  this 
hospital  going.   At  that  time,  it  was  the  last  phases  of  the 
Hill-Burton  money  to  build  new  hospitals.*  So  with  Burns 's  help 
and  connections  in  Sacramento,  we  got  approval  for  the  Hill-Burton 
funds  to  build  a  new  hospital.  We  had  about  a  million  dollars  or  so 
left  to  us  by  various  people.   Ed  Westgate,  who  was  on  the  board 
of  trustees  of  the  hospital,  was  a  contractor  and  developer.   He 
got  together  a  bank  consortium  to  lend  the  money  for  a  new  hospital. 


*The  Hill-Burton  Act  of  1946  provided  federal  money  to  build 
hospitals  across  the  United  States,  primarily  in  poor  and  rural 
areas,  with  stipulations  on  providing  some  free  care  to  indigents. 
At  least  9,200  hospitals,  clinics  and  health  centers  were  eventually 
built. 


169 


The  Bank  of  America## 


Gerbode:   The  day  before  the  meeting  of  the  consortium  was  supposed  to  occur, 
Ed  had  a  call  from  Rudy  Petersen,  the  president  of  the  Bank  of 
America.   The  president  of  the  Bank  of  America  said,  "Ed,  don't 
meet  the  consortium.   We'll  take  the  whole  thing."  I've  forgotten 
how  much  they  loaned  us,  something  like  eighteen  million  dollars 
or  so,  a  big  sum  of  money. 

Hughes:   Why  do  you  suppose  he  made  that  decision? 

Gerbode:   He  knew  that  there  was  connected  with  the  old  hospital  a  tremendous 
number  of  people,  old  friends,  old  patients,  faculty,  new  patients. 
He  knew  that  if  the  Bank  of  America  was  advertised  as  being  the 
backer  of  this  enterprise,  that  they'd  put  their  accounts  in  the 
Bank  of  America — which  is  true,  a  lot  of  them  did — and  that  the 
hospital  would  put  their  accounts  with  the  Bank  of  America.   It  was 
a  good  deal  from  their  point  of  view,  as  it  turned  out,  because  now, 
even  after  all  these  years,  we're  right  up  to  snuff  on  paying  off 
our  principal  and  interest,  and  we  have  money  in  the  bank.   So  that 
was  a  wise  decision. 


Designing  the  New  Presbyterian  Hospital* 


Gerbode:   We  got  the  hospital  built.   There  were  a  lot  of  design  characteristics 
of  the  hospital  which  were  influenced  by  the  fact  that  they  thought 
that  eventually   it  might  have  a  bigger  role  than  just  a  community 
hospital.   So  they  allowed  for  space  for  seminars  and  small  groups 
to  meet.    This  has  proven  to  be  very,  very  beneficial  for  conferences 
and  things  like  that. 

The  only  thing  they  didn't  build  into  the  hospital  was  a  big 
conference  hall.   But  they  finally  converted  something  which  was 
originally  designated  for  administration  into  a  meeting  [hall],  so 
they  have  a  conference  center  now. 

Hughes:   Did  you  have  a  role  in  the  design? 

Gerbode:   Yes,  I  did.   Luckily,  I  can  read  plans.   At  the  same  time  as  we 
were  designing  this  hospital,  they  were  designing  Stanford 
Hospital  in  Palo  Alto.   We  were  supposed  to  make  suggestions  about 


*See  the  session  recorded  on  5/22/84,  pp.  398-399,  for  further 
discussion  on  the  new  Presbyterian  Hospital. 


170 


Gerbode:   the  Stanford  Hospital  down  there.   In  fact,  Vic  Richards,  who  was 
then  chief  of  surgery  [at  Presbyterian],  was  supposed  to  go  down 
to  Palo  Alto  to  be  the  chief  down  there.   He  had  said  that  he 
would  move  to  Palo  Alto,  so  he  was  in  charge  of  the  design 
characteristics  of  part  of  the  new  hospital  in  Palo  Alto.   But 
actually,  what  he  would  do  is  put  the  plans  of  the  new  hospital  in 
Palo  Alto  up  in  the  operation  room  [in  San  Francisco],  and  then  he 
would  [ask  people  to  make  suggestions].   Well,  nobody  around  here 
was  going  to  make  any  suggestions.   So  as  a  consequence  of  this 
approach,  when  the  new  hospital  at  Stanford  was  built,  the 
department  of  surgery  was  very  small,  very  inadequately  represented. 
Whereas  Henry  Kaplan,  who  was  on  the  committee  for  selection  of  the 
architect  and  also  very  aggressive  in  what  he  wanted ,  was  there 
every  day  with  his  suggestions  about  the  department  of  radiology. 
As  a  consequence,  the  department  of  radiology  had  an  enormous 
complex  and  everything  they  wanted. 

Anyway,  coming  back  to  San  Francisco,  I  had  a  lot  of  fun  in 
the  beginning  when  we  built  this  research  building  [the  Institutes 
of  Medical  Sciences] ,  a  lot  of  fun  designing  the  dog  lab  and  other 
parts  of  it,  too.   I  went  through  the  business  of  getting  plans 
from  other  laboratories  which  had  been  built  in  the  country, 
particularly  the  one  which  Al  Blalock  had  built  at  Johns  Hopkins, 
and  used  some  of  their  plans  and  some  of  the  things  that  I'd  wanted 
in  the  design  of  this  research  building. 

Coming  back  to  the  hospital,  there  were  certain  things  which 
I  considered  to  be  important  from  the  surgical  point  of  view.   I 
felt  that  the  intensive  care  unit  should  be  on  the  same  floor  as 
the  operating  room,  because  there  are  lots  of  times  when  a  patient 
needs  to  go  back  to  the  operating  room  quickly.  Also,  after  an 
operation,  it's  very  bad  for  [patients]  to  be  in  an  elevator,  to 
have  to  go  to  another  floor,  because  at  that  critical  time,  they 
need  a  lot  of  care  quickly.   It's  better  for  them  to  get  into  the 
intensive  care  unit  right  away,  so  that  the  special  nurses  can 
take  care  of  them  and  monitor  them.   So  they  put  the  intensive  care 
unit  on  the  same  floor  as  the  operating  room. 


171 


Computerized  Patient  Monitoring* 


IBM 


Gerbode:   The  characteristics  of  how  it  was  designed  were  influenced  to  a 

certain  extent  by  the  research  we'd  been  doing  with  IBM  Corporation. 
We  began  to  use  computers  among  the  very  first  in  the  country. 
IBM  wanted  to  get  into  the  computer  business,  so  [Thomas]  Watson, 
[president  of  IBM],  himself,  came  out  with  a  small  committee  and 
met  in  the  library  here  on  this  floor  to  discuss  what  might  be  done 
in  monitoring  with  a  computer.   We  began  to  show  him  some  of  the 
things  we'd  done.   Jack  Osborn  had  gotten  together  some  very  nice 
illustrations  of  what  he  had  done  with  a  computer  which  somebody 
had  given  us. 

Finally  Mr.  Watson  turned  to  me  and  said,  "Dr.  Gerbode,  you've 
got  this  wrong.   We  didn't  come  out  here  to  have  you  sell  us  your 
program.   We  came  out  here  to  sell  you  our  program."   [laughter] 
I  said,  "That's  fine.   When  do  we  go  to  work?"  They  agreed  that 
they  would  put  their  main  research  emphasis  in  developing 
computerized  monitoring  in  our  hospital. 

Hughes:   What  was  the  date? 

Gerbode:   This  was  '60  or  '61.   We  signed  a  contract  with  IBM.   They  sent 
out  a  team  of  Ph.D.'s  to  work  with  us  full-time.   We  set  up  a 
computer  room  on  the  top  floor  of  this  research  building.  At  that 
time  everything  was  on  tape  with  big  disks,  so  this  huge  computer 
machinery  went  in  up  there,  at  the  expense  of  IBM,  with  their  full- 
time  people  running  it  and  connecting  it  with  the  old  hospital 
intensive  care  unit.   John  Osborn  worked  out  a  program.   On  our 
big  research  grant,  we  were  able  to  put  two  or  three  people  into 
this  computerized  monitoring  effort  as  full-time  research  people. 
So  the  joint  committee  worked  out  all  the  details  of  what  was 
necessary.   The  computers  got  smaller  and  smaller.   We  finally  got 
rid  of  those  big  machines.   IBM  worked  with  us  for  about  ten  years. 
They  spent  over  a  million  dollars  developing  the  programs  which 
were  largely  directed  by  John  Osborn. 

Hughes:   Meanwhile  computerized  monitoring  of  patients  was  spreading  to  other 
centers? 


*See  pp.  198-200  and  437-438,  for  further  discussion  of  computerized 
monitoring. 


172 


Gerbode:  Yes.  We  were  writing  papers  and  giving  talks,  and  people  were 

coming  out  to  see  what  we  were  doing  and  carrying  back  what  they 
thought  they  could  do  at  home.  After  it  was  successful,  another 
group  came  out  from  IBM  to  decide  what  they  wanted  to  do  next. 
They  decided  finally,  after  all  this  effort,  that  they  didn't 
want  to  go  into  the  front  end ,  which  is  the  sensing  end ,  where  you 
take  the  samples  and  get  a  result  and  then  put  that  number  for 
that  sample  into  the  machine.   They  didn't  want  to  develop  the 
front  end,  although  they  had  helped  us  develop  the  front  end 
initially.   They  said,  "We  have  demonstrated  how  to  use  the  computer. 
We'll  let  other  people  develop  the  front  end,  the  sensing  part  of 
it." 

Hughes:   Why  did  they  make  that  decision? 

Gerbode:   I  don't  know.   I  guess  they  just  didn't  want  to  do  it.   So  that 

meant  that  other  people  wanted  to  have  our  concepts  in  a  front  end 
console,  a  thing  that  you  could  move  up  to  the  patient,  take  the 
samples,  have  a  machine  analyze  them,  put  that  information  into 
the  computer.   So  Dr.  Osborn,  who  had  been  running  this  whole 
program  full-time,  decided  that  he  would  set  up  a  little  company  on 
Van  Ness  Avenue  and  make  front  ends.   Later  he  expanded  this  in 
South  San  Francisco,  and  finally,  after  it  became  successful,  he 
sold  it  to  Johnson  and  Johnson  for  about  three  million  dollars. 
He  got  a  million  dollars  for  himself,  or  something  like  that.   The 
institute  didn't  get  anything  back  out  of  that  whole  effort,  however. 

Hughes:   What  about  equipment  when  the  move  was  made? 

Gerbode:   That's  very  interesting.   Before  the  move  was  really  seriously 
decided  upon,  our  department  of  roentgenology  wanted  to  get  an 
angiography  unit  going.   So  they  applied  for  one  through  the  NIH, 
through  the  radiology  section,  and  were  turned  down.   I  was  on  the 
surgical  studies  section  at  that  time,  so  I  said,  "Why  don't  you 
reapply  and  put  it  through  the  surgical  studies  section?"  They  did, 
and  I  talked  long  and  hard  with  the  group  in  the  studies  section, 
and  they  finally  approved  building  a  cineangiography  machine  out 
here. 

Hughes:   Now,  was  that  still  in  the  early  stages? 

Gerbode:   It  was  the  first  one  out  here  in  the  West.   It  ran  for  a  couple  of 
years  very  successfully,  and  then  they  decided  that  they  were  going 
to  move  to  Palo  Alto  and  take  the  machine  down  there  with  them.   So 
that  meant  they  had  to  rip  it  out  and  reinstall  it  down  in  Palo  Alto. 
But  meanwhile,  the  state  of  the  art  had  improved  a  good  deal.   So 
the  next  generation  of  machines  came  along,  which  were  even  better. 


I 


Cardiopulmonary  Intensive  Care  Unit  in  the  old  hospital- 
the  first  computer  monitering  system. 


173 


Gerbode:   At  that  time,  a  man  by  the  name  of  [Newton]  Bissinger  was  in  the 
hospital  and  liked  very  much  how  he  was  treated  for  his  heart 
attack.   He  asked,  "How  can  I  help  you  fellows?"  They  said,  "Why 
don't  you  buy  us  a  new  angiography  machine."  So  he  did.   So  we 
got  the  latest  model  then,  and  they  had  taken  the  old  model  to 
Palo  Alto.   [laughter]   (But  a  few  years  later  they  got  the  new 
model  down  there,  too.) 

Hughes:   What  about  other  equipment? 

Gerbode:  The  other  equipment  was  very  expensive,  and  we  constantly  had  to 
raise  money  to  pay  for  our  share  of  the  development  costs  of  all 
that  equipment  in  the  intensive  care  unit. 

Hughes:   How'd  you  go  about  raising  money? 

Gerbode:   One  big  thing  I  did,  I  applied  to  the  Bothin  Fund  here  in 

San  Francisco,  which  is  run  by  the  descendants  of  the  Bothin 
family — Princess  Genie  de  San  Faustino  and  now  her  son,  Lymon 
Casey,  run  it — for  a  large  grant  to  support  the  development  of 
the  intensive  care  unit.   They  gave  us  a  lot  of  money  to  help 
complete  the  program. 

Hughes:   Do  you  think  most  of  this  was  thanks  to  the  growing  reputation  in 
cardiac  surgery? 

Gerbode:   Oh,  yes.   It  was  very  exciting.   The  other  thing  was  building  a 
new  hospital;  we  could  design  everything  so  they  could  put  the 
monitoring  equipment  in  properly. 

One  thing  I  insisted  on  was  not  to  have  the  electronics 
connected  with  monitoring  or  the  display  screens  in  view  of  the 
patients.   They  were  in  back  of  the  patient. 

We  designed  it  so  that  any  repairs  to  the  monitoring  equipment 
would  be  done  in  a  room  behind  tha  room  where  the  patient  was. 
So  there  was  a  wall;  in  front  of  the  wall  were  all  the  displays; 
in  back  of  the  wall  was  another  room  where  the  repair  people  could 
work  on  the  equipment  as  it  broke  down,  or  replace  it. 

Hughes:  In  general,  had  the  instrument  companies  jumped  6n  the  bandwagon 
very  quickly? 


174 


Hewlett-Packard 


Gerbode:  Oh,  yes,  they  did.  At  the  beginning  of  all  this,  I  went  down  to 
talk  to  Mr.  [William]  Hewlett  and  Mr.  [David]  Packard.   I  said, 
"Look,  we're  going  to  need  a  lot  of  this  work  done  in  monitoring 
patients,  sensing  devices  and  computers.  Why  don't  you  help  us? 
Why  don't  you  make  this  a  joint  effort?"  They  turned  me  down 
absolutely  flatly. 

Hughes:   Why? 

Gerbode:  Because  they  were  completely  sold  on  Stanford's  program,  and  they 

felt  that  if  they  helped  us,  it  would  be  disloyal  for  the  new  venture 
in  Palo  Alto.   So  they  put  all  their  money  into  Palo  Alto  and  didn't 
give  us  one  nickel.  Mr.  Hewlett's  father  was  professor  of  medicine 
up  here  in  the  old  medical  school.  There  was  even  a  local  society 
here  called  the  Hewlett  Society,  which  would  meet  once  a  month  in 
various  hospitals  and  have  clincal  sessions.   But  [Hewlett  and 
Packard]  were  both  absolutely  tied  into  Palo  Alto  and  Stanford  and 
I  suppose  decided  that  it  would  seem  disloyal  to  send  any  money  up 
here. 

Actually,  as  time  went  on,  they  bought  out  a  company — I  think 
it  was  called  the  Sanf ord  Company — which  was  engaged  in  the  business 
of  sensing  devices.   They  bought  them  out,  improved  on  them  and 
then  got  into  the  business  of  the  front  end  [sensing  device]  very 
seriously.  As  a  matter  of  fact,  now  we're  in  the  third  generation 
of  our  sensing  devices  in  the  hospital,  and  it's  mostly  Hewlett- 
Packard  stuff. 

Hughes:   What  did  you  do  when  they  turned  you  down? 

Gerbode:   IBM  came  in  voluntarily  Just  at  that  time  and  said  they  would  do 
it  for  us.   But  it  took  a  lot  of  money  to  build  that  unit  the  way 
it  is  now.  We  had  to  scrounge.   I  gave  a  lot  of  money  personally 
out  of  the  practice  to  it  and  had  people  make  contributions 
periodically.  Mrs.  Stevens  gave  the  money  for  the  coronary 
intensive  care  unit  [in]  the  intensive  care  unit.   She  gave  that  in 
memory  of  her  husband,  who  died  of  a  coronary.  Her  sister,  Mrs. 
Charles  Kuhn,  gave  another  room  there  for  coronary  patients,  because 
her  husband  had  died  of  a  coronary.   The  Bothin  Fund  finally  set 
up  a  clinical  research  area,  which  they  paid  for,  adjacent  to  the 
intensive  care  unit,  where  research  in  the  cardlorespiratory  diseases 
could  be  carried  on.   It's  still  being  used  for  that,  although  there 
are  some  clinical  units  in  there  now  which  are  using  some  of  the 
space  formerly  designed  for  pure  research.   We  can  be  very  grateful 
for  the  help  that  the  Bothin  Fund  gave  us. 


175 


Hughes : 


Research  Programs  at  the  Heart  Research  Institute 


How  were  you  dividing  up  your  research  and  your  surgery?  Did  you 
have  certain  days  when  you  were  in  the  dog  lab? 


Gerbode:   In  the  beginning,  I  was  in  the  dog  lab  most  of  the  time.  But  then 

as  we  worked  out  the  programs  and  got  busier  in  the  operating  room, 
we  shifted  some  programs  to  those  related  to  the  clinical  work. 
In  other  words,  we'd  study  patients. 


Postoperative  Problems  after  Open  Heart  Surgery* 


Gerbode:   One  of  the  principal  problems  in  those  days  was  to  find  out  why 

people  were  sick  after  open  heart  surgery.   Some  of  them  would  be 
mentally  confused  for  a  while.   Some  of  them  would  have  fevers 
which  were  unexplained.   So  a  lot  of  our  research  at  that  time  was 
to  find  out  why  the  patient  didn't  wake  up  as  quickly  as  after  a 
normal  operation.   It  was  something  to  do  with  the  machines.   So  we 
had  several  big  research  programs  going,  both  in  the  dog  lab, 
which  was  then  here  in  this  new  [medical  research]  building,  and  in 
the  operating  room. 

One  of  the  first  things  we  found  with  our  own  oxygenator,  which 
Bram  had  designed,  was  that  it  had  to  be  absolutely  meticulously 
cleaned.   Even  the  tiniest  bit  of  old  blood  in  there  would  cause  a 
fever  and  make  the  patient  sick  afterwards.   It  wouldn't  kill  him, 
but  it  would  make  him  sick  and  have  a  fever.   So  we  finally  realized 
we  had  to  clean  that  machine  with  concentrated  acid  to  get  everything 
out  of  it. 

Hughes:   Did  that  mean  taking  the  machine  completely  apart? 

Gerbode:   Completely  apart,  and  it  had  to  be  taken  over  to  Cutter  Laboratories. 
We  were  constantly  sending  them  over  by  car  and  bringing  them  back. 
We  ended  up  by  having  twelve  of  them  in  rotation.   It  was  expensive 
and  cumbersome.   We  found  out  a  lot  of  things  about  what  happened 
to  blood  in  machines,  and  wrote  quite  a  few  papers  on  it. 


*See  the  session  recorded  on  5/22/84,  pp.  370-371. 


176 


The  Bramson  Membrane  Oxygenator 


Gerbode:  At  the  same  time,  we  were  working  experimentally  on  the  membrane 

oxygenator.   We  had  a  team  specifically  assigned  to  that,  Bram  and 
another  engineer.   Cutter  Laboratories  had  a  group  on  it,  too. 
Then  we  began  to  use  it  for  long-term  profusions  in  the  experimental 
laboratory.   That's  when  Dr.  [Donald]  Hill  came  aboard  and  ran  a 
series  of  dogs  on  the  membrane  to  see  how  long  you  could  keep  an 
animal  alive  on  it.  We  had  others  working  in  the  lab,  too,  on 
various  projects.   Dr.  David  Hill  did  some  very  good  work  on 
membranes  as  did  Dr.  [John]  Wright  from  Australia.   This  was  going 
on  while  the  program  was  developing  clinically.   I  eventually  used 
the  membrane  in  over  300  operations. 

Hughes:   Were  people  coming  specifically  to  work  on  this  particular  project? 

Gerbode:  No.  We  developed  our  own  research  team  locally  out  of  people  who 
were  with  us. 


Heart -Lung  Machines  Elsewhere 


Hughes:   Is  it  appropriate  to  talk  about  what  else  was  going  on  in  the 

country  and  in  the  world  in  regard  to  the  heart-lung  machine  during 
this  time? 

Gerbode:  Yes.  There  were  different  kinds  of  heart-lung  machines  being  developed 
in  several  places  in  the  country.   Several  big  corporations  were 
manufacturing  heart-lung  machines  commercially,  based  on  the  research 
done  mainly  in  labs  like  ours  or  universities.   The  membrane 
oxygenator  work  was  being  carried  on  under  [Willem]  Kolff  at  the 
University  of  Utah  and  a  couple  of  other  places.  As  an  outgrowth  of 
that,  there  are  several  membranes  on  the  market.   Ours  is  still  no<; 
on  the  market,  but  we  hope  to  get  it  on  the  market  soon.* 

Hughes:   How  far  along  were  Gibbon  and  that  group  when  you  were  working  on 
the  membrane? 

Gerbode:   Gibbon  never  got  into  membrane  oxygenators.   In  fact,  he  didn't  do 
anything  beyond  developing  a  screen  oxygenator.  As  people  began  to 
test  what  was  happening  to  blood,  they  found  that  the  screen 


*The  commercial  fate  of  Dr.  Gerbode 's  membrane  oxygenator  is  discussed 
on  pp.  349-352. 


A  version  of  the  Bramson 
membrane  oxygenator: 
initially  used  at  Pacific 
Medical  Center  for  open 
heart  surgery,  later  used 
for  patients  whose  lungs 
have  collaped  from 
disease  or  injury. 


Left  to  right: 

J.  Donald  Hill,  Frank  Gerbode, 
John  Osborn,  Mogens  "Bram"  Bramso: 
with  a  version  of  the  membrane 
lung  machine. 


177 


Gerbode:   oxygenator  was  not  very  good,  was  not  very  easy  on  blood,  either. 
It  was  also  very  difficult  to  clean,  for  the  same  reason  that  I 
mentioned  with  our  disk  oxygenator.   You  had  to  clean  it  so 
meticulously  that  it  was  a  big  chore.   In  Gibbon's  own  unit,  very 
soon  after  he  had  retired  from  the  chairmanship  of  the  department, 
chey  switched  to  a  bubble  type  of  oxygenator,  and  the  Mayo  Clinic 
did  the  same. 

Hughes:    Is  one  of  the  advantages  of  the  membrane  oxygenator  that  you're 
developing  that  the  membrane  is  disposable? 


Platelets 


Gerbode:   That's  one  thing.   But  the  other  is  that  it's  less  traumatic  to 
blood.   If  you  study  platelets,  for  example — we  did  some  of  the 
original  work  on  platelets  here — you  find  that  whatever  machine  you 
use,  in  the  first  few  minutes  of  any  perfusion,  the  platelet  count 
goes  way  down.   The  platelets  simply  disappear  from  the  blood. 

So  we  tried  to  find  out  what  happened  to  the  platelets.   David 
Hill  found  out  in  our  laboratory,  that  they  went  into  the  liver 
temporarily.  They  went  into  hiding,  so  to  speak.   Then  slowly,  after 
the  perfusion  was  over,  they'd  come  back  into  the  circulation.   With 
a  bubble  oxygenator,  they'd  come  back  much  more  slowly  and  not 
completely.   With  a  membrane  oxygenator,  they'd  come  back  slowly, 
but  they  came  back  almost  completely  and  faster  which  meant  that 
they  weren't  made  as  sick  while  they  were  hiding  in  the  liver,  or 
on  their  way  to  or  from  the  liver.   This  was  rather  a  basic  discovery. 

Hughes:   That  meant  no  clotting  then. 

Gerbode:   Well,  the  fact  that  the  platelets  disappeared  meant  that  the 

patients  bled  more  postoperatively.   We  frequently  had  to  give  them 
platelet  transfusions. 

Hughes:   Were  the  platelet  transfusions  a  direct  outgrowth  of  the  discovery 
that  platelets  were  going  into  seclusion? 

Gerbode:   No.   We  discovered  that  we  had  to  <jive  them  platelet  transfusions 
because  the  platelet  counts  were  so  low.   We  didn't  know  at  that 
time  where  the  platelets  had  gone  or  what  had  happened,  but  we  knew 
that  they  weren't  in  the  circulation.   So  we  had  to  give  them  platelets 
to  build  up  the  quantity  so  that  the  blood  would  clot.   The  [Irwin 
Memorial]  Blood  Bank  had  to  develop  methods  of  getting  platelets  out 
of  bank  blood,  so  we  could  give  platelet  transfusions.   They  developed 
that  quite  successfully. 


178 


Hughes:   That  was  developed  here  in  this  blood  bank? 

Gerbode:   It  was  developed  in  various  laboratories  throughout  the  world. 

Everybody  at  that  point  was  having  more  or  less  the  same  experience. 

Hughes:   Is  it  mainly  the  platelets  that  are  disturbed? 

Gerbode:  No,  other  things  happen,  too,  to  red  cells.   Some  of  the  red  cells 
hemolyze  and  other  clotting  factors  are  affected. 


The  Institutes  of  Medical  Sciences  (Continued) 
[Interview  7:  August  26,  1983 ]## 


Gerbode:  We  had  something  over  two  hundred  thousand  dollars  of  approved 

research  grants  for  the  people  who  were  not  going  to  move  to  Palo  Alto. 
I  asked  the  National  Institutes  of  Health,  the  Cancer  Society,  and 
a  few  other  grantors  if  they  would  be  willing  to  transfer  these  funds 
from  Stanford  to  the  Institutes  of  Medical  Sciences,  and  they  all 
said  they  would.   Stanford  University,  in  addition,  said  they  would 
not  object  to  doing  this. 

Most  of  these  grants  were  for  research  in  circulation  and  heart, 
but  there  were  some  smaller  grants  in  eye  research.   In  any  event, 
we  started  out  with  an  institute  called  the  Heart  Research  Institute, 
which  I  directed  with  Jack  Osborn.   Then  later  on  Dr.  [Arthur] 
Jampolsky  started  an  eye  institute.   Subsequently  an  institute  of 
neurological  sciences  was  started  as  well  by  Knox  Finley. 

As  time  went  on,  other  institutes  developed.   For  example,  some 
years  later  George  Williams,  who  had  been  director  of  the  laboratories 
at  the  NIH  hospital  in  Bethesda,  decided  to  retire  and  move  to 
California.   So  he  established,  with  some  private  funding  an 
institute  of  aging  and  brought  some  people  with  him  to  set  this  up. 

Various  other  people  have  come  into  the  research  programs. 
The  general  feeling  has  been  that  we  didn't  want  to  have  too  many 
separate  institutes,  but  we  have  ended  up  with  seven.   Probably  one 
or  two  are  small  enough  so  that  they  shouldn't  really  be  institutes. 
Dr.  William  Kuzell  got  a  million  dollars  [from]  a  grateful  patient 
to  set  up  an  arthritis  institute,  which  is  going  very  well. 

It  was  not  difficult,  really,  to  get  the  research  started, 
although  there  has  always  been  a  problem  with  space.  We  had  a 
beautiful  animal  laboratory  set  up  in  the  new  research  building. 


179 


Gerbode:   At  times  it  has  been  difficult  to  find  enough  research  to  keep 
that  animal  laboratory  funded  properly,  so  they've  had  debates 
about  whether  it  should  be  a  core  facility.   But  presently  this 
has  been  worked  out.   For  a  long  time  we  had  a  tremendous  amount 
of  work  in  the  animal  laboratory  testing  devices,  such  as  heart- 
lung  machines  and  membrane  oxygenators,  and  so  forth. 

Politically,  there  really  weren't  very  many  problems,  except 
relative  to  space.   This  had  to  do  with  people  wanting  to  have 
more  laboratories  and  more  office  space  for  their  research  workers   , 
and  looking  at  others  who  perhaps  weren't  utilizing  their  space  as 
well  as  the  others  thought  they  should  be.   But  we  established 
some  committees  to  settle  these  matters,  and  finally  formulae  were 
worked  out  so  that  there  was  very  little  hard  feeling  about  it. 

Gradually,  from  a  single  woman  running  the  office  and  taking 
care  of  the  bookkeeping,  we  have  added  more  and  more  people  until 
now  we  have  a  rather  huge  staff  of  administrative  people.   We  worry 
about  it  being  greater  than  it  should  be ,  but  bureaucracy  always 
grows.   You  can't  stop  it  very  easily.   So  now  at  this  moment  we 
have  a  lay  president,  an  executive  vice  president,  personnel  managers, 
chief  accountants,  bookkeepers,  and  all  sorts  of  other  people 
keeping  track  of  the  approximately  three  million  dollars  of  expendable 
funds  every  year. 

Hughes:    Is  there  a  medical  president  as  well? 

Gerbode:   No,  there  isn't.   We  have  had  medical  presidents  in  the  past.   In 
fact,  I  was  president  for  about  three  years.  We  had  various  other 
doctors  who  were  president,  but  they  resigned  for  better  positions. 

One  of  the  best  ones  we  had  was  Dr.  James  Hundley,  who  came  to 
us  from  Washington.   We  liked  him  very  much  and  he  was  very 
effective.   He  got  to  be  so  good  and  well  known  that  the  American 
Heart  Association  offered  him  quite  a  bit  more  money  than  we  could 
pay  him  and  some  other  prerogatives,  so  he  left  and  went  to  New  York 
to  run  the  American  Heart  Association.   But  within  six  months  he 
was  disillusioned  not  only  about  the  job  but  also  about  how  he  had 
to  live  in  New  York,  and  a  short  time  later  resigned,  moved  back 
to  California,  where  his  daughter  was  living  in  Mar in  County.   A 
month  or  so  later  he  was  killed  by  a  truck  in  a  highway  accident, 
which  was  very  sad.   We  would  have  been  very  happy  to  take  him  back 
again,  but  unfortunately  the  accident  prevented  this. 


180 


Administration 


Gerbode:  We've  had  a  lot  of  debates  and  some  infighting  about  how  the 
institute,  which  is  now  the  Medical  Research  Institute  of  San 
Francisco,  should  be  administered.   It's  been  my  belief  that  we 
should  have  a  research-oriented  Ph.D.  or  M.D.  who  is  knowledgeable 
about  research  funding  and  research.   The  rest  of  the  administration 
can  be  run  by  people  who  know  about  bookkeeping  and  things  like 
that. 

However,  some  of  the  people  at  MRI  have  been  afraid  of  having 
a  strong  research  man  as  head  of  MRI  because  they,  I  guess,  believe 
that  he  might  interfere  with  their  work  or  make  suggestions  about 
some  of  the  private  funds  which  have  come  into  some  of  the 
institutes.   They  were  afraid  to  accept  the  premise  that  we  should 
have  a  really  high-caliber  research  person  running  it.   So  now  we 
have  a  president*  who  is  fund  raising  for  the  ballet  association 
and  other  things  in  town  and  who  is  a  social  figure,  but  he  doesn't 
know  anything  about  research.   He  is  acceptable  to  most  people,  but 
some  people  still  feel,  as  I  have  all  along,  that  we  should  have  a 
thoroughbred  research  person  in  the  job. 

Hughes:   So  the  way  it  stands  now,  all  research  policy  is  established  by  the 
director  of  each  institute? 

Gerbode:  Yes.   But  then  we  have  a  board  of  trustees,  and  they  establish 

broad  policies.   We  have  a  science  council  which  also  participates 
a  great  deal  in  establishing  policies  relative  to  research,  and 
various  other  committees  which  come  into  the  picture  relative  to 
space  and  finance. 

Hughes:   The  board  of  trustees  would  not  make  decisions  concerning  scientific 
and  medical  matters? 

Gerbode:  No,  it  wouldn't. 

[telephone  interruption] 

Gerbode:   The  board  establishes  broad  policies  and  also  can  form  and  terminate 
institutes.   They've  never  terminated  one  yet,  but  they  think 
about  it  once  in  a  while  when  institutes  run  out  of  funding.   They 
also  have  trouble  deciding  how  to  set  up  a  new  institute.   It's 
easier  for  them  to  believe  that  money  should  be  the  determinant. 
I  don't  believe  in  this.   I  think  it's  a  mistake  to  advertise  that 


*The  president  of  MRI,  James  Ludwig,  resigned  in  March  1984. 


181 


Gerbode:   we  will  establish  an  institute  because  a  certain  group  has 

x  numbers  of  dollars.   I'd  rather  have  them  have  fewer  dollars 
but  bigger  ideas. 

Hughes:   Aren't  the  strikes  against  you  in  a  sense  if  the  board  is  composed 
of  people  without  predominantly  scientific  or  medical  interests? 

Gerbode:   It  is  difficult  because  they  don't  really  understand  research.   It's 
very  hard  to  find  lay  people  who  really  understand  voluntary 
research  efforts.   This  is  generally  true  throughout  the  world 
except  in  some  places  where  people  have  made  fortunes  out  of  their 
research  and  development.   Then  they  understand  the  beginnings  of 
an  idea  and  how  it  develops  into  something  worthwhile  and  profitable. 

We  are  one  of  the  ten  largest  private  research  organizations 
in  the  country,  and  we  are  known.   We  belong  to  all  the  voluntary 
nonprofit  research  organizations  in  the  country.   So  it  is  an 
effective  and  strong  institution.   It's  the  biggest  [private  research 
insitute]  in  San  Francisco.   There  isn't  anything  else  here  that 
could  match  it  except  for  the  University  of  California.   It  has 
by  far  a  much  bigger  budget  with  many  more  researchers  than  when 
the  [Stanford]  medical  school  was  here. 

Hughes :   What  is  the  division  of  labor  between  the  board  of  trustees  and 
the  science  council? 

Gerbode:   The  science  council  is  composed  of  scientists.   Each  institute  can 
appoint  two  members  of  the  science  council.   They  discuss  things 
like  compensation  and  the  value  of  the  science.   They  determine  who 
gets  money  which  has  been  awarded  on  a  broad  basis  to  the  institute 
as  a  whole.   For  example,  NIH  gives  us  a  grant  every  year  based  on 
how  much  money  we  have  raised  ourselves.   This  amounts  to  anywhere 
from  eighty  to  ovex  a  hundred  thousand  dollars  a  year.   It's  called 
a  basic  research  support  grant.   The  science  council  reviews 
applications  from  the  scientists  in  MRI  applying  for  money  in  this 
BRSG  fund.   Everybody  accepts  its  decision  pretty  well. 

Hughes:   NIH  doesn't  place  any  stipulations  about  how  the  money  will  be 
spent? 

Gerbode:   No.   The  BRSG  fund  is  to  be  used  to  stimulate  new  research,  to 

encourage  young  people  to  get  into  research,  to  support  research 
which  is  ongoing  but  is  periodically  short  of  funding  in  various 
categories.   It's  really  quite  a  great  thing  to  have  this  fund. 
It's  certainly  to  the  credit  of  NIH  that  they  recognized  the 
necessity  for  it. 


182 


Research 


Hughes:   Is  most  of  the  research  fairly  directly  connected  with  medical 
practice? 

Gerbode:  Originally  practically  all  the  research  was  connected  with  medical 
problems  we  saw  in  patients.   This  was  certainly  true  of  the  heart 
research  program,  because  we  had  to  develop  heart-lung  machines  and 
learn  how  to  take  care  of  very  seriously  ill  heart  patients  who 
had  operations  and  who  needed  operations.  We  also  had  to  perfect 
the  instrumentation  to  manage  them  safely.   But  more  recently  we've 
had  research  efforts  which  are  very  basic,  particularly  in  the  field 
of  immunology.  We  have  a  lot  of  immunology  going  now.  One  big 
group  has  come  forward  after  about  seven  or  eight  years  with  a 
method  of  making  interferon  more  inexpensively  than  anybody  else. 
So  they're  about  ready  to  burst  out  of  our  lab  into  a  big 
production  somewhere  in  Hayward  and  really  begin  to  sell  their 
product. 


Commercialization 


Hughes:   Is  there  any  problem  with  going  commercial? 

Gerbode:  No,  there's  no  problem.   Actually,  the  same  thing  was  true  of  our 
developing  a  membrane  oxygenator,  which  we  spent  so  many  years 
working  on  and  finally  have  gotten  it  to  the  point  where  a  commercial 
firm  has  taken  it.  They've  spent  about  a  million  dollars  developing 
it  to  the  point  where  it  can  be  sold.   In  the  end,  whenever  it  is 
sold,  we  will  get  royalties.   The  royalties  don't  go  to  persons; 
they  go  back  into  a  heart  research  fund  which  will  be  used  for 
other  research. 

Hughes:   Do  individuals  own  the  patent? 

Gerbode:  With  regard  to  our  membrane  oxygenator,  individuals  relinquished 

their  patents,  or  sold  their  patents  to  the  Harvey  Company.  We  no 
longer  hold  any  patents,  but  we  have  an  agreement  with  the  Harvey 
Company  that  when  [the  machines]  go  into  production  we  will  get  a 
royalty.   The  same  thing  is  true  of  the  group  who  has  developed  the 
method  of  producing  interferon.  Assuming  that  they  don't  forget 
about  their  commitment ,  we  should  get  a  fair  amount  of  money  back 
into  our  research  efforts. 


183 


Gerbode: 

Hughes : 

Gerbode: 
Hughes: 

Gerbode: 


We  have  some  people  who  have  gotten  patents  on  various  devices,  and 
we  have  policies  established  for  that.  The  policies  usually  either 
give  all  the  royalty  money  to  research  programs  or  split  it  between 
MRI  and  the  individual. 

So  that  would  be  a  real  incentive  for  an  investigator  to  come 
here. 

Oh  yes. 

I'm  thinking  of  the  problems  that  have  arisen  at  U.C.  in  connection 
with  recombinant  DNA  and  the  fact  that  the  university  holds  the 
patents. 

Yes.   Well,  we  let  the  individual  hold  patents  mostly.   We  have  an 
agreement  with  the  individual,  if  he's  developed  the  new  idea  or 
the  instrument  in  MRI,  that  we  will  share  in  any  rewards  that  come 
out  of  it.   I  must  say,  we  haven't  made  much  money  from  this  so  far. 
But  a  great  deal  of  what  you  do  in  research  is  built  on  hope. 


Administrative  Policy 


Gerbode:   Another  thing  I  should  say  about  the  total  research  effort  is  that 
we  have  brought  people  here  to  give  them  an  opportunity  to  do 
research  without  interfering  with  them.  We  don't  even  tell  them 
what  to  do.  We'll  help  them  do  their  research  and  answer  questions 
and  make  constructive  suggestions  if  they're  requested.   But  we 
don't  look  down  anybody's  neck  at  all.   We  want  to  create  an 
atmosphere,  as  I  mentioned  before,  of  freedom  of  thought  and  freedom 
of  activity. 

This  is  quite  different  from  the  usual  university  research 
structure,  where  everything  is  under  a  departmental  head,  and 
depending  upon  what  he  likes  or  dislikes,  the  research  can  either 
go  forward  or  stop.   This  has  to  do  with  space  and  a  lot  of  other 
political  factors  in  a  university  structure.   We  wanted  to  avoid  all 
that. 

Hughes:    So  the  director  of  an  institute  has  a  much  looser  hold  on  his 
membership  than  the  head  of  an  academic  department? 

Gerbode:   If  you  want  to  take  me  as  an  example  of  a  director,  I've  brought 
people  in  who  have  independent  thoughts  about  what  they  wanted  to 
do  in  their  research,  and  give  them  space,  helped  them  a  little  bit 


184 


Gerbode:   financially  one  way  or  the  other  with  equipment  or  personnel,  and 
let  them  go,  let  them  run  with  it.   The  only  thing  we  insist  on 
is  that  they  do  it  honestly  and  present  their  results  in  scientific 
journals. 

Hughes:   So  you  do  pay  attention  to  publication? 

Gerbode:   We  encourage  them  to  publish  as  much  as  possible,  but  these  fellows 
usually  realize  that  their  survival  depends  on  publication.   So 
they  usually  crank  out  as  much  as  they  can. 


The  Peer  Review  System 


Gerbode:   Research  is  really  governed  by  peer  review  committees  in  various 
ways.   Every  NIH  grant  is  reviewed  by  a  peer  review  group  in 
Washington  or  wherever  they  want  to  have  the  meetings.   They  look 
it  over  very  carefully,  and  [the  applications]  are  all  very 
competitive.   If  a  peer  review  group  in  NIH  gives  a  grant 
application  a  rating  of  two  or  two  and  a  half  or  three,  there  is 
very  little  chance  of  it  being  funded. 

Hughes:   What  is  the  scale? 

Gerbode:  One  to  five.   Five,  of  course,  is  a  complete  reject.   They  don't 
even  hardly  look  at  it.   The  competition  is  between  the  ones  and 
twos.   Currently  I  think  that  practically  anything  that  gets  bigger 
than  a  two  rating  has  very  tough  going. 

Hughes:   Maybe  this  is  the  time  to  say  a  bit  about  what  criteria  are  used 
for  these  peer  review  committees. 

Gerbode:  A  research  grant  is  submitted  to  a  particular  section  of  NIH.   That 
section  has  a  study  section  committee  which  reviews  all  these 
applications.   They  look  at  each  application  [to  determine]  whether 
or  not  the  prospect  of  accomplishing  the  goal  set  out  by  the  research 
worker  is  reasonably  possible  or  not,  and  also  whether  or  not  the 
type  of  research  fits  in  to  what  we're  trying  to  do  generally  in  the 
country.   In  other  words,  we  know  right  now  that  cancer  and 
arteriosclerosis  are  the  two  big  killers,  so  generally  speaking 
something  related  even  remotely  to  these  would  be  looked  upon  more 
favorably  than  others. 


185 


Gerbode:   However,  there  are  a  great  many  other  projects  that  are  valid  and 
worthy.   So  they  look  at  the  people  and  the  research  environment. 
They  look  at  the  track  record  of  those  involved,  the  promise  of 
the  individuals,  and  the  age  of  the  individuals.   They're  more 
inclined  to  favor  a  grant  to  a  younger  person  than  to  an  older 
person. 

Hughes:    Is  the  feeling  there  to  give  the  younger  person  a  chance? 

Gerbode:   Part  of  it,  because  in  the  country  as  a  whole* we  want  to  get  young 
people  interested  in  research,  so  we  favor  giving  them  some  money 
to  get  them  started.   Also,  there  is  generally  a  feeling  that  after 
forty  or  forty-five,  the  prospect  of  any  original  research  coming 
out  of  a  worker  is  slimmer  and  slimmer  as  time  goes  on.   Unfortunately 
for  this  generalization,  not  infrequently  it  doesn't  apply  at  all. 
Some  of  the  best  projects  come  from  older  men.  But  in  general,  the 
committees  favor  younger  people. 

Hughes:   Does  NIH  give  you  criteria  by  which  to  judge  the  applications? 

Gerbode:   No,  they  don't.   The  peer  group  establishes  its  own  criteria.   It 
evaluates  the  program  suggested  by  the  application  and  either 
accepts  it  with  a  priority  or  rejects  it. 

Hughes:    Is  it  pretty  much  on  the  scientific  merits? 

Gerbode:   It's  not  political.  Although  over  the  years,  it  was  obvious  to 
me  that  if  one  of  the  Ivy  League  medical  schools  applied  for 
something,  it  was  much  more  apt  to  get  it  than  some  little 
university  in  the  Midwest.   But  time,  I  think,  has  changed  that  a 
bit.   I  think  people  began  to  realize  that  you  could  do  good 
research  in  a  lot  of  different  places  in  the  United  States  other 
than  New  England.   Some  of  the  very  best  things  are  not  done  in 
New  England  or  the  East  Coast. 

Hughes:   Do  you  think  that  the  system  works  pretty  well? 

Gerbode:   I  think  the  system  is  excellent.   The  American  Heart  Association  has 
similar  committees  which  examine  these  applications.   In  fact,  the 
local  heart  association  does,  too.   They  have  a  research  committee 
which  looks  at  all  the  applications  and  votes  on  them. 


186 


The  Institutes  of  Medical  Sciences  (Continued) 


Hughes:   Back  to  the  Institutes,  if  you  don't  mind.   The  subject  of  choosing 
investigators.   The  way  I  understood  your  explanation  was  that  a 
man  would  come  here  with  a  specific  project  in  mind. 

Gerbode:  Yes.   Very  often  they've  already  been  working  in  a  particular  field 
on  a  particular  problem  and  have  already  established  a  track  record. 
For  example,  they  may  be  studying  the  immunological  aspects  of 
cancer,  and  they  would  have  some  publications  and  worked  in 
laboratories  somewhere.   For  one  reason  or  another,  the  person 
wants  to  leave  that  institution,  either  because  he  doesn't  like 
the  climate  politically  in  the  institution  or  the  climate  otherwise, 
or  because  his  wife  or  husband  wants  to  move  to  another  part  of  the 
country.  We  have  gotten  people  from  the  University  of  California 
locally  because  of  departmental  problems  which  they  didn't  like 
there.  The  same  thing  is  true  of  the  Veterans'  Hospital.   We've 
gotten  some  people  from  there  as  well  because  they'd  rather  work  in 
a  free-standing  institution  where  politics  is  at  a  minimum  and 
they  can  really  do  their  thing  without  interference. 

If  you  pursue  this  policy,  you're  apt  to  get  stronger  people. 
This  sometimes  can  cause  difficulties,  because  when  they  come  into 
our  complex,  they  want  to  swing  the  bat  and  influence  things  a  bit, 
too.   Well,  that's  fine.   I  think  that's  being  a  good  citizen.   So 
I  don't  mind  that,  providing  they'ro  fair  about  it. 


Teaching  and  Training  Programs 


Hughes:   Since  the  institutes  are  not  set  up  along  strict  academic  lines, 
what  do  you  do  about  such  things  as  teaching  and  exchanging 
information  among  the  institutes? 

Gerbode:  Those  are  good  questions.   We've  always  had  some  kind  of  training 
going  on.   In  fact,  for  a  while  we  had  a  Ph.D.  program  with  the 
University  of  the  Pacific.   In  cardiovascular  work  we  had  a  master's 
program  with  the  University  of  the  Pacific.   Both  of  these  have 
been  dropped  now  because  of  no  takers,  mainly  because  doing  graduate 
work  in  a  university  which  is  eighty  miles  away  in  Stockton  is 
difficult.   If  the  university  were  on  this  campus,  we'd  have  more 
of  these  programs  going.   There  is  currently  again  talk  of  reviving 
the  Ph.D.  program  in  one  or  two  of  the  disciplines. 


187 


Hughes:   Would  that  mean  taking  on  new  staff? 

Gerbode:   No,  we'd  use  our  own  staff.   Right  now  we're  talking  more  about 

having  postdoctoral  fellowships,  which  is  a  form  of  teaching.   We 
would  take  on  people  as  fellows  who  have  gotten  their  Ph.D.'s 
and  want  to  get  started  in  a  good  research  program  and  get  them 
going  until  they  can  stand  on  their  own  feet.  We're  going  to  do 
more  of  that  in  the  future. 

We  have  also  always  had  a  summer  student  program.   During  one 
summer  program  Dr.  Osborn  and  I  had  twelve  students  working  here 
in  cardiovascular  surgery.   It  was  like  running  a  boy  scout  camp, 
[laughter]   I  must  confess,  it  was  just  too  much. 

Hughes:   What  level  were  these  students? 

Gerbode:   They  were  mostly  university  students,  premed  or  in  biological 

sciences  or  engineering.   It  is  interesting  to  note  that  many  of  them 
have  later  gone  to  medical  school  and  have  done  very  well. 

More  recently  we've  lowered  the  number  of  summer  students  to 
three  or  sometimes  four.   These  are  sponsored  by  the  local  Heart 
Association  or  by  a  local  woman's  group,  ARCS,  who  sponsor  summer 
students'  stipends.   I  must  say,  they  are  very  generous  with  their 
stipends,  too. 

In  the  hospital  we  take  a  certain  number  of  externs  in  various 
departments  for  part  of  a  year,  because  most  medical  schools  in 
the  world  now  have  some  free  time  for  the  students  to  go  away 
somewhere.   The  West  has  always  looked  good  to  people  everywhere, 
so  we  always  have  a  lot  of  people  wanting  to  come  to  California. 
We  can  always  take  a  certain  number.   Unfortunately,  they  can't 
do  anything  more  than  observe  and  take  histories.   They  can't  treat 
or  write  orders  because  of  being  foreign  students. 

#1 

Hughes:   What  if  they're  American  students? 

Gerbode:   American  students  can  do  that,  and  we  have  externs  who  can  write 
orders  and  help  in  the  operating  room. 

Hughes:   What  body  would  choose  those  students? 

Gerbode:   Those  students  are  chosen  by  the  department  of  education  of  the 

hospital.   They  have  a  director;  he  or  she  runs  all  the  interns  and 
residents  and  would  run  the  externs  or  fellows,  too. 

Hughes:   How  closely  are  the  institutes  and  the  hospital  affiliated? 


188 


Reasons  for  Establishing  a  Medical  Research  Institution 


Gerbode:  Well,  we  should  talk  a  little  bit  about  why  there  is  a  research 
organization  here  at  all,  and  then  what  is  the  relation  of  the 
research  to  the  hospital.   Being  the  person  who  founded  all  this, 
when  Stanford  left,  my  idea  was  that  someday  there  might  be 
another  medical  school  here.  And  if  you  were  seriously  thinking 
about  having  another  medical  school,  then  one  of  the  things  you 
would  have  to  have  is  a  group  of  people  interested  in  research. 
Since  there  were  a  number  of  people  who  wanted  to  do  research  and 
were  not  going  to  move  to  Palo  Alto,  I  felt  that  they  should  be 
put  together  in  some  kind  of  an  organization.   I  think  I've  mentioned 
this  before  to  a  certain  extent. 

I  also  had  a  very  strong  feeling  that  any  medical  institution 
dealing  with  patients  would  be  a  better  one  if  there  was  research 
going  on  at  the  same  time.   I  think  the  best  hospitals  and  clinics 
in  the  country  are  those  which  have  good  research  programs.   It  not 
only  improves  the  quality  of  medicine  in  the  institution,  but  it 
brings  people  around  who  are  interested  in  basic  problems  relative 
to  health.   When  they're  talking  about  it  and  giving  seminars,  it 
sharpens  the  ordinary  clinician. 

This  has  been  true  here.   I  believe  the  fact  that  we  have  all 
these  research  people  around,  some  of  them  working  with  doctors  in 
the  hospital,  and  others  working  on  problems  which  the  doctors  can 
see,  is  very  beneficial.   The  problem,  of  course,  is  that  many  of 
the  clinical  departments  in  the  hospitals  are  run  by  the  people 
who  don't  care  or  know  much  about  research.   They're  good  doctors, 
but  they're  not  interested  in  discovery  or  scientific  matters. 

Hughes:   Does  that  make  it  difficult  when  an  investigator  is  ready  for 
patient  trials? 

Gerbode:   It's  almost  impossible,  if  a  research  worker  wants  to  do  a  clinical 
program  in  research,  to  get  it  accomplished  unless  the  departmental 
chief  wants  it.  And  then  you  get  back  to  the  same  thing  that 
happens  in  the  universities.   But  so  far  we  haven't  really  had 
much  problem  with  that.   The  ones  who  don't  do  any  research  and  who 
are  in  charge  of  departments  at  least  don't  try  to  stop  research 
if  it  doesn't  interfere  with  them  too  much  and  as  long  as  they  don't 
have  to  pay  for  anything. 

Hughes:   But  there's  no  system  set  up  for  any  sort  of  automatic  acceptance? 


189 


Gerbode: 


Hughes : 
Gerbode; 

Hughes : 
Gerbode: 


Hughes : 
Gerbode: 


Nothing's  automatic.   Currently  we're  trying  to  get  hospital 
research  increased,  and  we  currently  have  a  joint  research  committee 
of  trustees  and  research  people  in  the  hospital  and  MRI.   They 
meet  quarterly.   Currently  the  general  policy  decision  is  that  all 
research  for  both  should  be  administered  through  MRI.   This  is  a 
bit  difficult  sometimes  because  people  leave  money  to  the  hospital 
for  research,  and  the  hospital  doesn't  like  to  turn  that  money  over 
to  somebody  else.   They  want  to  try  to  run  it  one  way  or  the  other. 
That's  perfectly  natural. 

I  would  think  also  that  the  hospital  would  resist  having  MRI 
have  control  over  the  decision. 


You  see,  the  problem  is  that  there  aren't  many  people  in  the 
hospital  who  can  make  [scientific]  decisions  [about  research], 
we  [in  MRI]  have  a  big  advantage  there. 


So 


I  would  think  that  the  same  would  apply  to  the  board  of  trustees. 

It  does  apply  to  the  board  of  trustees,  absolutely.   For  example, 
one  of  the  most  important  people  on  the  board  of  trustees  of  the 
hospital  once  said  at  a  board  meeting,  "I  think  all  of  the  research 
we  do  should  be  directed  toward  improving  patient  care  in  the 
hospital  or  problems  in  our  patients."   In  other  words,  you  find 
out  that  a  certain  group  of  patients  gets  warts  when  they  come  to 
the  hospital;  therefore  the  research  program  should  be  designed  to 
eliminate  this  strange  phenomenon.   [laughter]   That's  kind  of  an 
exaggeration.   He's  trying  to  liken  the  research  in  a  hospital  to 
that  in  IBM  or  Hewlett-Packard  or  some  big  corporation,  or  even  the 
stock  market.   These  big  people  engaged  in  the  stock  market  all 
have  research  organizations.   It's  all  designed  to  help  them  make  a 
decision  relative  to  investing  their  money,  or  somebody's  money. 
But  so  much  of  research  cannot  be  pointed  to  a  specific  problem  of 
the  day. 

I  think  that's  very  difficult  for  a  layman  to  grasp. 

Even  doctors  have  difficulty  understanding  it.   I  would  say  in 
general,  however,  that  our  research,  as  I  mentioned  earlier,  was 
designed  to  try  to  overcome  some  of  the  difficulties  in  applying 
treatments  which  we  were  ready  to  apply  but  couldn't  apply  until 
we  understood  how  to  apply  them  better.   This  was  certainly  true 
of  open  heart  surgery.   That's  why  we  spent  so  much  money  on 
developing  techniques  and  instrumentation  and  studying  the  physiology 
of  what  happens  when  you  use  [heart-lung]  machines. 


190 


Hughes:   Would  you  say  that  your  research  today  is  still  pretty  much  with 
the  idea  of  future  application? 

Gerbode:   I  think,  generally  speaking,  our  research  is  basically  clinically 
oriented.   Even  the  work  in  immunology  and  interferon  is  certainly 
intimately  related  to  cancer  and  a  number  of  other  basic  things 
we're  working  on  so  seriously.  The  people  running  the  clinical 
programs  in  the  hospital  don't  really  do  any  basic  research.   I  think 
the  people  in  MRI  are  better  informed  on  what  the  problems  in 
basic  research  are  and  how  to  try  to  solve  them. 

Hughes:   I  asked  a  question  about  communication  and  you  mentioned  the 

committee  which  brings  together  the  hospital  and  MRI.   Is  there 
anything  that  does  that  for  the  institutes  as  a  whole? 

Gerbode:  We  have  weekly  scientific  conferences  to  which  all  the  hospital  and 
MRI  people  are  invited.  They  are  usually  basic  science  lectures  of 
one  kind  or  another  describing  the  work  which  an  individual  is 
engaged  in,  what  he's  accomplished  and  what  he  hopes  to  do.   Some 
of  them  are  quite  lively,  because  a  lot  of  good  questions  are  asked. 

Hughes:   They're  well  attended? 

Gerbode:  No,  the  hospital  people  practically  never  come.  The  younger 

research  people  come,  the  ones  whose  careers  really  are  based  on 
what  they  might  be  able  to  do  [in  research].   Usually  when  we  bring 
a  new  person  in,  one  of  the  first  things  we  do  is  give  him  a 
chance  to  give  a  talk  or  two  to  all  the  other  research  workers  about 
what  he  wants  to  do  "or  what  he  can  do.  Those  are  pretty  well 
attended  because  people  are  kind  of  curious  to  see  what  the  new 
person  looks  like. 


Ph.D.s  and  M.D.s 


Hughes:   What  about  the  ratio  of  Ph.D.s  to  M.D.s  in  the  institute? 

Gerbode:   I'd  say  that  90  percent  of  the  research  is  done  by  Ph.D.s  or 

masters.  Originally  it  was  the  other  way  around;  it  was  mostly 
M.D.s.   But  M.D.s  find  they  can  make  a  lot  more  money  and  have  an 
easier  life  in  practice  rather  than  trying  to  compete  for  funds  to 
do  research.   Funding  organizations  don't  pay  research  workers  very 
much. 


191 


Hughes:   That  of  course  is  feeding  into  some  of  the  problems  you  see  between 
the  hospital  and  the  institute. 

Gerbode:   Oh  yes.   There's  a  constant  deep  feeling  of  the  Ph.D.s  that  they 

are  underpaid  and  they  are  the  martyrs  of  the  system,  because  they 
don't  make  nearly  as  much  money,  and  they  feel  as  though  they're 
making  all  the  big  contributions  toward  the  improvement  of  medicine. 
But  I've  told  them  whenever  this  comes  up,  "If  you  wanted  to  be  a 
doctor,  you  should  have  gotten  an  M.D.  degree."  It's  easier  to  get 
an  M.D.  degree  frequently  than  it  is  to  get  a  Ph.D. 

One  fellow  who  worked  with  us  had  a  Ph.D.,  and  he  kept  saying 
this  all  the  time.   I  said,  "Go  get  an  M.D.  degree."  So  he  did, 
and  he  continued  doing  research  at  the  same  time  he  was  getting  his 
M.D.  degree.   But  I  must  say  that  his  research  suffered  and  was 
really  questionable.   But  as  a  consequence  of  this  change  in 
direction,  he  is  now  a  faculty  member  in  a  clinical  department  in 
New  England.   I  presume  he's  still  doing  some  research  back  there 
in  the  clinical  department.   At  least  he's  making  more  money. 

Hughes:   Going  back  to  when  the  institutes  were  first  being  formed,  what 
would  you  say  then  was  the  reason  for  adding  a  new  institute? 
Was  it  a  matter  of  money? 


Founding  New  Institutes 


Gerbode:   Yes.   It  was  a  matter  of  money — well,  not  so  much  money,  but  a 

group  of  people  who  could  be  funded.   In  other  words,  you  had  to  be 
sure  that  a  person  to  whom  you  gave  a  laboratory  could  run  it 
financially. 

We  didn't  have  any  set  figures,  though.   We  simply  looked  at  the 
group  and  if  they  had  a  pretty  good  track  record  and  had  the 
promise  of  going  somewhere,  we'd  give  them  space  and  help  them. 

Hughes:   Was  there  any  tie-in  with  current  scientific  and  medical  problems? 

Gerbode:   In  other  words,  have  we  decided  that  we  should  go  into  certain 
fields  because  we  feel  they're  important? 

Hughes:   Yes. 


192 


Gerbode:  Yes,  to  a  certain  extent.  When  George  Williams  wanted  to  set  up 
an  institute  of  aging,  we  thought  that  was  very  good,  because 
aging  is  something  we're  faced  with  everyday!   In  fact,  Mrs. 
Florence  Mahoney,  who  used  to  be  on  our  board — she's  a  wonderful 
and  very  effective  woman  in  Washington — felt  so  strongly  about  the 
aging  question  that  she  worked  hard  on  certain  senators  and  finally 
got  them  to  approve  an  aging  institute  as  one  of  the  institutes  in 
NIH.   I  notice  that  they've  got  very  good  appropriations  now,  and 
she's  very  proud  of  the  fact  that  she  did  it. 

Our  aging  work  has  dropped  of f  a  bit  because  of  poor  funding. 
Dr.  Williams  has  shifted  his  interest  into  cancer  research. 

Hughes:   In  connection  with  the  aging  problem? 
Gerbode:  Well,  not  really. 


Sharing  Equipment  and  Facilities 


Hughes: 
Gerbode: 


Hughes: 


Gerbode: 


You  touched  upon  the  question  of  equipment, 
ideal  but  not  an  actuality  at  the  moment? 


Is  shared  equipment  an 


As  a  general  rule,  every  research  worker  Likes  to  have  his  own 
"microscope."  He  doesn't  like  to  share  it  with  anybody  else.   So 
mostly  the  institutes  and  the  research  workers  have  their  own 
research  instrumentation.  However,  when  it  gets  to  big  things, 
no  one  institute  can  afford  to  buy  them  and  maintain  them,  so  we  do 
share  certain  things. 

We  have  two  things  which  currently  are  examples  of  this.  We 
have  a  research  lab  which  is  called  a  core  facility  lab,  which 
contains  certain  expensive  equipment,  such  as  spectrophotometers , 
that  can  be  shared  by  a  number  of  workers.   We  also  have  a  machine 
shop  which  can  make  beautiful  equipment  out  of  metal,  make  almost 
any  instrument.  Anybody  can  go  over  there  who  can  afford  to  pay 
for  whatever  they  need,  and  can  get  it  done. 

What  about  the  use  of  the  core  facility  lab?   I  would  think  that 
sometimes  there  would  be  tremendous  competition  between  institutes. 

No,  they  get  together  and  say,  "Would  you  mind  if  I  use  it  on 
Tuesday?"  or  something  like  that. 


Hughes:   So  it's  an  informal — 


193 


Gerbode:   Informal   arrangement,  sure.   They  are  very  fair  about  it.   So 
there's  never  been  much  problem  about  that. 

Hughes:   The  dog  lab  is  used  by — ? 

Gerbode:   The  dog  lab  is  now  used  by  a  number  of  people,  but  not  nearly  as 

much  as  it  was  a  few  years  ago.   However,  they  do  dog  and  cow  work 
two  or  three  times  a  week.   The  instruments  and  the  respirators 
are  shared.   There's  a  basic  charge  for  using  the  animal  laboratory; 
for  each  experiment  there  is  a  basic  charge.   That  goes  into  a  fund 
in  central  administration  which  then  pays  for  replacement  of 
instruments  and  materials,  drugs  and  things  like  that. 

Hughes:   Why  has  use  fallen  off? 

Gerbode:   I  guess  the  main  reason  is  that  some  of  the  people  who  were  using 
it  a  lot  are  so  busy  in  practice  now  that  they  don't  use  it  as 
much  because  they're  busy  taking  care  of  sick  people. 

Hughes:   Do  you  wish  to  say  anything  more  about  the  institutes? 


Accomplishments  and  Reputation 


Gerbode:   I  think  my  premise  that  a  hospital  complex  with  a  research  institute 
would  be  a  much  better  place  to  be  working  and  a  much  better  place 
for  sick  people  has  been  accomplished.   I  think  the  fact  that  we 
have  a  very  strong  medical  research  institute  here  has  increased 
the  value  and  prestige  of  the  [Pacific  Medical  Center]  enormously 
and  has  increased  the  quality  of  care  of  patients  a  great  deal.   I 
think  quite  a  few  people  envy  us. 

Hughes:   What  would  you  say  about  the  reputation  of  the  institutes  on  a 
national  scale? 

Gerbode:   Their  reputation  is  very  good.   NIH  and  their  committees  never 

hesitate  to  consider  an  application  from  MRI.   It's  considered  on 
an  equal  basis  with  universities. 

Hughes:   Has  that  always  been  the  case? 

Gerbode:   It  was  pretty  much,  because  when  we  started  we  had  reputations  back 
there,  and  I  was  on  several  committees  myself. 


194 


Hughes:   That  helped.   Should  we  talk  about  the  relationship  of  the  institute 
with  other  research  organizations?   I'm  thinking  of  Stanford  and 
U.C. 

Gerbode:  We've  always  had  some  joint  programs,  not  great  ones.   For  example, 
in  the  kidney  transplant  work,  which  has  now  reached  a  level  which 
is  among  the  best  in  the  country,  there  are  research  programs 
which  are  shared  by  Stanford  and  ourselves.  What  will  happen  to 
those  programs  in  the  future  I  don't  know,  because  Stanford  now  is 
going  to  have  a  kidney  transplant  unit  of  its  own. 

Hughes:   Will  some  of  the  people  go  down  there? 

Gerbode:  Well,  they'll  have  their  own  sources  of  patients,  because  they  have 
a  lot  of  people  with  sick  kidneys  come  in  there.   I  think  they'll 
get  enough  work  to  keep  a  kidney  transplant  team  going.   By  the 
same  token,  we're  probably  going  to  do  heart  transplants  here. 

Knowledge  is  generally  shared  in  these  ventures.   People  who 
are  working  in  a  field  usually  share  their  experiences  pretty 
freely. 

Hughes:   A  particularly  strong  field,  say  the  kidney  transplant  program, 

would  that  influence  the  research  of  another  institute?  I'm  thinking, 
for  example,  of  the  tie-in  with  immunology. 

Gerbode:  Oh,  very  much  so.   There's  a  lot  of  cross-fertilization. 


The  Decision  to  do  Heart  Transplantations  at  Pacific  Medical  Center 


Hughes:   What  about  the  decision  to  have  heart  transplantation  here? 

Gerbode:   First  of  all,  you  have  to  have  a  team  that  feels  as  though  it  can 
do  it.  We  have  a  very  strong  cardiovascular  department  here,  with 
very  good  backup  in  postoperative  care,  and  we  have  the  kidney 
transplant  program,  which  then  brings  in  all  the  various  aspects 
of  controlling  the  rejection  phenomenon.   They're  pretty  knowledgeable 
about  that  now,  too,  so  that's  a  help.   And  then  the  fact  that  organs 
are  offered  to  the  kidney  program  means  that  there  are  hearts 
available  as  well,  as  there  are  eyes.   So  we  have  a  corneal 
transplant  group  here  which  has  been  in  existence  for  many  years. 
If  you're  taking  organs  for  one  purpose  you  can  usually  get  the 
other  organ  as  well,  so  these  programs  help  each  other. 


195 


Gerbode:   I'm  sure  that  part  of  the  reason  why  Stanford  is  going  into  kidney 
transplants  is  because  they  already  have  all  the  other  elements 
of  what  goes  into  transplantation.   All  they  need  is  to  have 
somebody  to  do  the  work. 

Hughes:    Is  the  motivation  for  setting  up  one  of  these  programs  the  idea 

that  you're  going  to  help  patients  with  severe  problems,  or  is  it 
a  money-maker?  Or  both? 

Gerbode:   I  think  a  great  deal  of  it  really  is  the  objective  of  having  a 
complete  center.   People  want  to  be  responsible  for  starting 
something  and  running  it.   It  does  have  some  financial  aspects,  of 
course,  because  people  have  to  make  a  living.   If  they  make  a 
little  extra  money  and  it's  doing  what  they  want  to  do,  then  more 
power  to  them.   The  only  feeling  I  have  about  that  is  that  if  a 
person  does  get  into  a  field  where  the  money  comes  in  pretty 
liberally,  I  feel  the  person  should  put  something  back  into  the 
organization. 

Hughes:   That  doesn't  usually  happen,  does  it? 

Gerbode:  No,  unfortunately  it  doesn't  happen.  But  I  can  say  that,  as  far  as 
I  was  concerned,  over  the  years  I've  put  as  much  back  into  HRI  as  I 
took  home.  Otherwise  it  wouldn't  have  gone. 

Hughes:  You  said  earlier  that  one  reason  that  you  didn't  become  involved 
with  heart  transplantation  was  the  problem  of  rejection.  Do  you 
really  think  that  that  has  been  handled? 

Gerbode:   Oh,  it's  been  handled  pretty  well  now,  because  they  have  drugs  that 
can  control  it.   They  have  ways  of  studying  the  heart  to  see 
whether  a  rejection  is  imminent  or  not.   Then  they  temporarily 
fire  up  the  drugs. 

I  think  [transplantation]  is  accepted,  and  I  think  it's  going 
to  increase  in  numbers  and  quality.   I  think  pancreas  transplantation 
is  going  to  be  accepted  very  widely  pretty  soon,  and  liver  transplanta 
tions  more  than  they  are  now.* 

Hughes:   Neither  of  those  is  done  here? 
Gerbode:   No. 


*There  is  further  discussion  of  transplantation  on  pp.  468-469 
in  the  session  recorded  on  5/30/84. 


196 


Ethical  and  Psychological  Considerations  in  Medicine 


Hughes:   There  are  a  lot  of  ethical  problems  connected  with  any  form  of 
transplantation.  Have  committees  been  set  up  to  handle  these 
questions? 

Gerbode:  Oh  yes.   There  are  committees  all  over  the  place.  There  are 

committees  in  the  United  States  Senate.   There  are  committees  in 
the  Heart  Association,  committees  in  the  medical  societies,  and  . 
local  hospital  committees.   We  have  a  joint  committee  of  MRI  and 
the  hospital  which  has  to  approve  any  research  program  that  involves 
humans.   It  has  to  go  through  that  committee  on  human  experimentation. 
If  we  invent  a  device  for  the  treatment  of  something  which,  let  us 
say,  requires  a  continuous  intravenous  drip  to  administer  a  drug, 
it  has  to  go  through  this  committee,  and  they  have  to  consider 
whether  it  might  be  harmful.  And  all  the  people  on  whom  this 
particular  venture  will  be  tried  have  to  sign  a  paper  saying  they 
understand  what's  going  on,  that  it  is  experimental,  and  relinquish 
any  lawsuits  or  conditions  about  it.   It  doesn't  really  prevent 
a  full  lawsuit,  but  it  makes  people  a  little  more  aware  of  the  fact 
that  they're  engaging  in  something  which  is  a  new  venture. 

Hughes :   Are  the  criteria  used  by  this  committee  set  up  by  the  committee 
itself,  or  are  they  government  criteria? 

Gerbode:   Some  of  them  [have  been  established  at  the  national  level].   For 
example,  the  question  of  when  death  occurs,  what  is  death:  that 
has  been  debated  at  all  levels  in  the  country.   So  finally  criteria 
to  establish  death  have  been  established. 

Hughes:   Which  is  brain  death. 

Gerbode:   Yes. 

Hughes:   How  does  that  sit  with  you  as  a  heart  man? 

Gerbode:  Oh,  I  think  that's  fine,  because  if  a  person's  brain  is  dead  and 

you're  keeping  the  patient  alive  through  machines  at  great  expense 
and  with  no  ultimate  outcome,  I  think  it's  a  waste  of  effort  and 
money.   If  the  family  would  be  willing  to  donate  the  organs  of  that 
person,  that's  great.   People  are  generally  accepting  brain  death 
in  the  country  and  in  the  world  [as  a  criterion  of  death] . 

If 

Hughes:   In  cases  where  the  patient  is  literally  dying,  it  makes  "consent" 
rather  questionable.   The  patient  is  hardly  going  to  be  looking  at 
the  situation  from  an  objective  standpoint. 


197 


Gerbode:   Yes.   Now  we're  getting  into  things  which  are  not  essentially 
related  to  research. 

Hughes:   That's  true.   But  they  are  things  which  must  be  dealt  with. 

Gerbode:   Yes.   Usually  we've  dealt  with  those  things  by  talking  to  the 

family,  the  husband  or  the  wife.   If  you  can't  get  through  to  the 
patient,  spell  out  the  facts  to  the  husband,  wife  or  family  in 
some  form,  and  record  in  the  chart  the  fact  that  you  have  done  all 
,   this,  so  that  it  is  well  known  that  you  have  covered  the  risks 
and  the  essential  aspects  of  what  you  intend  to  do.   It  isn't  a 
complete  protection  against  being  sued,  but  it  certainly  helps  a 
great  deal. 

Hughes:  What  about  the  moment  when  you  decide  that  research  in  the  dog  lab 
or  wherever  has  progressed  far  enough  and  it  is  now  time  to  do  the 
procedure  on  a  human?  What  goes  into  making  that  decision? 

Gerbode:   If  you've  done  it  repeatedly  in  the  lab,  you  know  how  to  do  it 

technically,  and  you've  seen  the  result  physiologically  or  otherwise, 
then  it  is  time  to  apply  it.   You  simply  go  to  the  patient  and  tell  him 
that  you've  been  working  on  this  now  for  a  year  or  so  and  have 
"done  it  repeatedly  in  animals,  and  this  is  the  best  treatment  for 
you,  or  your  son  or  daughter  or  husband  or  wife.   Do  you  want  us  to 
try  it  or  not? 

Hughes:   You  would  make  it  clear  that  it's  a  new  procedure? 

Gerbode:  Oh  yes,  make  it  clear  and  write  it  all  down  in  the  che.rt ,  and  the 
history.   Sometimes  people  have  gone  to  the  point  of  having 
[patients]  sign  a  document  [which]  reads  something  like,  My  doctor 
has  told  me  all  the  risks  connected  with  this  venture  and  explained 
all  the  various  possibilities,  and  I  hereby  give  him  consent  to 
apply  it. 

Hughes:  Is  that  something  that  the  individual  physician  would  ^decide  to  do 
or  not  do? 

Gerbode:   Yes,  that's  right. 

Hughes:   Are  most  patients  willing  to  go  ahead  with  a  new  procedure? 

Gerbode:   Yes,  they  are.   If  they're  in  a  hospital  with  a  good  reputation 
and  dealing  with  good  people,  they're  willing.   I  never  really 
had  difficulty,  even  in  the  early  days  of  open  heart  surgery,  getting 
people  to  agree  to  have  the  operations.   You'd  present  the 
statistics,  the  facts,  the  problems.   On  the  one  hand  there's 
hope;  on  the  other  hand  there  isn't  much  hope. 


198 


Hughes:   What  about  your  frame  of  mind  when  you  are  trying  a  new  procedure 
for  the  first  time  on  a  human?  Do  you  think  you're  tenser? 

Gerbode:   I  think  I've  always  been  pretty  aware  of  what  the  risks  were  and 
what  the  promise  would  be.   For  example,  if  you  can  close  a  hole 
in  the  heart  successfully,  and  a  given  patient  has  done  better 
with  that  hole  closed,  then  you're  really  quite  excited  about  it, 
because  there  are  lots  of  holes  around  to  be  closed. 

Hughes:   But  when  you're  starting  on  the  first  closure,  how  do  you  feel? 

Gerbode:   I  think  if  you've  tried  it  out  on  animals  and  thought  it  out 

carefully  and  you  know  what  other  people  have  tried — it's  like 
going  through  a  forest ,  you  can  see  the  marks  on  the  trees  and  the 
path,  and  you  watch  out  for  wild  animals.   [laughs]   But  you'll 
get  through  it  all  right. 

Hughes:   So  the  psychological  step  is  not  that  great  from  the  dog  lab  to  the 
human? 

Gerbode :   It ' s  much  harder  to  get  a  survival  in  a  dog  than  it  is  in  a  human 
for  a  given  situation. 

Hughes:   Why  is  that? 

Gerbode:  A  lot  of  reasons.  One  thing  is,  you  have  some  ways  of  treating 
human  beings  which  you  don't  have  in  animals.   But  also,  many 
animals  are  not  as  resilient. 

Hughes:   Is  that  just  an  inbred  characteristic? 

Gerbode:   I  don't  really  know.   But  I  think  it's  generally  true. 


Computerized  Patient  Monitoring  (Continued)//// 
[Interview  8:  August  29,  1983] 


Hughes:   We  talked  previously  about  computerized  monitoring  of  patients,  but 
I  don't  think  we  really  brought  out  how  innovative  this  whole 
procedure  was.   I'd  like  you  to  comment  on  that,  and  also  say 
something  about  what  impact  the  technique  had  on  medicine. 


199 


Gerbode:   When  IBM  came  to  us,  they  obviously  felt  that  using  a  computer  would 
be  of  benefit  to  the  treatment  of  patients.  We  of  course  had  felt 
this  all  along  and  had  therefore  started  using  a  computer  to  monitor 
certain  physiological  events  in  the  postoperative  care  of  patients. 

The  obvious  things  one  would  think  about  [monitoring]  would 
be  the  blood  pressure,  the  venous  pressure,  and  the  heart  rate.   But 
then  there  were  so  many  metabolic  things  which  were  important  in 
the  treatment  of  a  seriously  ill  patient,  it  was  our  decision  to 
monitor  some  of  these  as  well.   So  we  developed  methods  of  following 
the  CC>2,  the  work  of  respiration,  and  a  number  of  other  very 
useful  parameters,  and  put  them  into  a  program  which  would  come  out 
as  a  display  on  a  screen  for  a  nurse  to  watch.   We  could  also  have 
laboratory  tests  put  into  the  computer  so  that  [patients]  could 
come  back  into  the  recovery  room  immediately,  as  soon  as  they  were 
finished  [with  the  operation].   The  nurse  then  would  not  have  to 
wait  for  a  piece  of  paper  to  come  from  a  lab  or  a  telephone  call;  it 
would  be  there  as  soon  as  the  test  was  completed.   So  we  had 
terminals  set  up  in  the  laboratories  to  put  these  bits  of  information 
into  the  patient's  computerized  record.   Dr.  John  Osborn  with  the 
assistance  of  IBM's  James  Beaumont  was  in  charge  of  this  project. 

We  ended  up  by  being  able  to  monitor  on-line  twelve  very 
important  parameters.   This  is  very  sophisticated  medicine,  because 
when  a  nurse  or  a  doctor  can  look  at  twelve  physiological  effects 
in  a  seriously  ill  patient,  he  or  she  has  a  lot  of  very  useful 
information.   What  actually  happened  after  a  while  is  that  nurses 
got  to  be  expert  at  interpreting  these  data  and  could  make  decisions 
themselves  about  giving  blood  or  changing  the  respirator:   increasing 
the  amount  of  respiratory  pressure,  the  volume  of  respiration,  the 
amount  of  oxygen,  a  lot  of  things  like  this. 

I  likened  the  use  of  a  nurse  in  this  capacity  [to]  flying  an 
airplane  with  the  use  of  instruments  rather  than  with  the  seat  of 
her  pants.   If  you  learn  how  to  fly  an  airplane  with  instruments, 
you  can  fly  it  through  hail  and  storms  and  everything,  but  if  you 
are  doing  it  with  the  seat  of  your  pants,  you  sometimes  get  into 
terrible  trouble.   This  obviously  requires  a  certain  amount  of 
intelligence,  and  we  were  lucky  to  have  nurses  who  were  very 
intelligent.   Furthermore,  once  they  learned  the  method  of  following 
patients  with  the  computer,  they  liked  it  very  much.   Some  of  them 
left  the  hospital  for  various  reasons  to  go  to  other  hospitals,  but 
they  always  tried  to  get  back  again,  because  they  felt  more  comfortable 
having  precise  information. 

Hughes:   Did  they  have  to  go  through  a  training  program? 


200 


Gerbode:  We  had  a  training  program  set  up  for  them.   We  had  one  girl  in 
charge  of  training  all  of  the  new  girls  and  checking  them  out. 
Kay  Martz  was  her  name.  She  now  has  left  the  unit  and  has  gone  to 
live  with  her  husband  in  Modesto.   But  she  has  trained  other  people 
in  the  art  of  training  nurses,  so  the  system  goes  on. 

The  concept  of  having  this  on-line  observation  of  patients 
was  quickly  copied  by  other  units.   Actually  Dr.  Osborn  later  put 
together  a  little  company  so  that  he  could  make  the  front  end,  the 
sensing  devices,  so  the  signals  could  go  into  the  computer.   These 
devices  now  are  being  sold  to  various  other  hospitals  throughout  the 
world.   The  Johnson  and  Johnson  Company  bought  the  little  company, 
and  they  now  are  in  the  process  of  making  and  selling  them. 

[Computerized  monitoring]  is  a  very,  very  sensible  way  of 
following  patients.   When  you  get  reliable  information,  you  don't 
guess  so  much. 


201 


VI  MEDICAL/SURGICAL  ACTIVITIES  AND  HONORS 


The  Frank  Gerbode  Medical  Research  Foundation 


Hughes:   Now  the  Gerbode  Medical  Research  Foundation. 

Gerbode:   A  few  years  ago  several  members  of  the  board  of  [what  was]  then 
IMS  [the  Institutes  of  Medical  Sciences] ,  which  is  now  MRI  [the 
Medical  Research  Institute],  thought  it  would  be  a  good  idea  to 
have  an  endowed  chair  in  my  name.   So  they  decided  to  have  a  small 
fund  raising  activity  to  establish  this  chair.   Actually,  as  time 
went  on,  it  turned  out  to  be  more  reasonable  to  have  a  foundation 
which  would  support  research  than  to  have  a  chair,  although  they 
could  function  similarly  as  far  as  using  money  is  concerned. 

Anyway,  this  was  set  up  as  a  nonprofit  foundation.   Funds  were 
raised.   I  must  say  that  they  didn't  pursue  a  very  vigorous  fund 
raising  campaign,  which  was  fine  with  me  because  it's  kind  of 
embarrassing  to  sit  here  and  have  people  raising  money  for  you  in 
this  way.   Anyway,  they  did  raise  a  certain  amount  of  money,  and 
this  has  been  used  to  support  new  research,  support  young  people 
getting  started  in  research,  and  to  pay  for  equipment  and  other 
expenses  which  were  not  foreseen  in  the  beginning  of  any  program. 
One  is  always  short  of  money  in  research. 

Contributions  come  in  slowly.   The  trustees  decided  that  they 
would  not  use  the  capital  but  only  the  income  from  the  fund.   This, 
then,  meant  that  there  wasn't  very  much  money  to  spend.   But  still, 
it's  better  in  the  long  run  to  keep  a  capital  fund  going,  I  think, 
than  it  is  to  spend  it  all.   [The  foundation]  continues,  and  I 
imagine  it  will  continue  in  the  future. 

Hughes:   Can  more  than  one  individual  be  supported  at  a  time? 


202 


Gerbode:  What  we  do  is  support  parts  of  programs;  when  somebody  has  a  new 
idea  and  isn't  funded  for  it,  providing  that  what  he  requests 
doesn't  cost  too  much  money,  we  can  help  get  him  started  or  get 
him  over  a  hurdle. 

Hughes:   Is  it  unusual  to  have  an  endowed  foundation  connected  with  a 
private  research  foundation? 

Gerbode:  The  Smith-Kettlewell  Institute  of  Visual  Sciences  has  some  monies 
which  are  used  in  a  similar  way,  and  they  had  several  big  grants 
given  to  then.  They're  a  bit  out  of  MRI,  though.   There  are  no  other 
MRI  endowed  chairs  or  funds  of  this  kind,  except  for  the  Smith- 
Kettlewell  funds. 

Hughes:   But  other  private  research  institutions  do  have  endowed  chairs? 

Gerbode:  Yes,  they  do.  Universities  have  them.  I  know  there's  one  in  honor 
of  Vic  Richards  at  Children's  Hospital.  I  think  that's  mainly  used 
to  help  research  in  that  hospital. 

Hughes:  The  establishment  of  the  foundation  was  an  idea  that  developed  from 
your  colleagues? 

Gerbode:  No,  it  really  came  from  several  of  the  institute  directors.   It  wasn't 
from  the  doctors.   Doctors  really  don't  give  very  much  money  for  other 
doctors.   There's  only  one  other  group  that's  worse  than  that  and 
those  are  the  lawyers.  Lawyers  don't  give  any  money  to  other  lawyers. 


Professional  Societies  and  Associations* 


Hughes:   Now  let's  turn  to  your  membership  in  professional  associations,  of 
which  there  certainly  are  many.  What  I  did  is  to  single  out  a 
few  which  seemed  to  me  to  be  significant  or  in  which  you  had  held 
office.   Certainly  you're  free  to  add  more  to  the  list. 


The  American  Association  for  Thoracic  Surgery 


Hughes:   Perhaps  you'd  like  to  start  by  talking  about  the  American  Association 
for  Thoracic  Surgery.  You  were  vice  president  from  1971  to  1972 
and  president  from  1972  to  '73. 


*For  further  discussion  of  professional  societies,  see  the  discussion 
recorded  on  11/14/84,  pp.  477-483. 


203 


Gerbode:   The  American  Association  for  Thoracic  Surgery  is  the  largest  and 
most  prestigious  thoracic  and  cardiovascular  organization  in  this 
country.   I  felt  very  highly  honored  that  they  made  me  president. 
I  had  served  on  various  committees  along  the  way,  the  membership 
committees  for  one  thing  for  several  years.   It  has  an  annual 
meeting.   That  meeting  is  always  attended  by  a  vast  number  of 
thoracic  surgeons  in  the  country,  most  of  whom  are  not  members. 
There  are  many  people  who  come  from  other  countries  to  attend  the 
meeting  as  well.   For  example,  Europeans  are  always  heavily 
represented  at  the  meeting.   It's  a  very  friendly  meeting  to  attend, 
too.   The  atmosphere  is  very  good.   The  scientific  papers  I  think 
are  among  the  best  in  this  particular  category  anywhere. 


The  Society  of  Thoracic  Surgeons 


Gerbode:   There's  another  society  called  the  Society  of  Thoracic  Surgeons, 

which  was  started  many  years  later  because  it  was  felt  that  younger 
thoracic  surgeons  needed  to  have  their  own  organization,  many  of  whom 
could  not  get  into  the  American  Association  for  Thoracic  Surgery. 
It  has  very  good  meetings  annually  as  well.   Generally  speaking, 
there  are  more  younger  people  attending  it.   The  attendance  has 
always  been  excellent  right  from  the  very  beginning. 

Hughes:   The  associations  have  membership  by  appointment,  by  election? 

Gerbode:   Yes.   Your  name  is  usually  submitted  by  two  or  three  people  who  write 
letters  of  recommendation.   Then  you  have  to  send  in  your  curriculum 
vitae  and  list  of  publications.   Then  you  go  through  a  long  process 
of  being  looked  over  by  the  membership  committee.   The  society 
usually  accepts  the  recommendation  of  the  membership  committee. 


The  American  Surgical  Association 


Gerbode:   The  American  Surgical  Association  is  another  very  prestigious 

American  [organization].   I  was  fortunate  in  being  made  a  member  of 
that  quite  a  while  ago,  too.   That  probably  is  the  most  prestigious 
of  all  the  surgical  associations  in  this  country.   Most  of  the  men 
in  it  have  done  quite  a  bit  of  teaching  or  research,  have  a  lot  of 
publications  and  are  more  or  less  in  a  leadership  position,  mostly 
in  universities  in  the  country,  although  not  entirely. 


204 


Hughes:   Is  the  American  Association  for  Thoracic  Surgery  also  inclined 
toward  research  people? 

Gerbode:   It's  inclined  toward  people  who've  done  teaching  and  some  research, 
although  there  are  some  people  who  are  members  who've  done  most  of 
their  work  along  the  experimental  line.   But  in  general  the  member 
ship  favors  people  who  are  in  university  settings. 


The  Society  of  University  Surgeons 


Gerbode:  Another  quite  prestigious  society  is  called  the  Society  of  University 
Surgeons.   That  was  started  just  before  or  around  the  time  of  the 
war  for  young  people  who  wanted  to  have  university  careers.   The 
criteria  for  selection  to  membership  really  had  to  do  with  whether 
the  young  man  was  showing  promise  in  research  or  publications  and 
looked  as  though  he  was  going  to  go  on  into  an  academic  career  of 
some  kind.   They  made  me  a  member  when  I  was  quite  new  in  the 
academic  field.   I  enjoyed  those  meetings  a  great  deal.   The 
presentations  in  that  society  are  now  so  exotic  that  sometimes  you 
can't  even  understand  what  they're  talking  about.   [laughter]   The 
young  men  are  presenting  the  papers  mostly,  and  they're  in  the 
forefront  of  some  pretty  sophisticated  kinds  of  research  and  they 
like  to  talk  about  it,  too.   The  meetings  are  very  exciting  from 
that  point  of  view.   Certainly  I  think  the  new  things  which  come 
aboard  in  surgery  are  more  apt  to  be  seen  at  the  meetings  of  the 
Society  of  University  Surgeons. 

Hughes:   You  had  mentioned  earlier  that  attendance  at  meetings  was  one  way 
that  you  kept  abreast  of  new  developments. 

Gerbode:  Yes.   Most  of  these  societies  require  attendance.   If  you  don't 

attend  three  meetings  in  a  row  without  an  adequate  excuse,  they  may 
drop  you,  or  at  least  you  get  a  threatening  letter.   If  I  can't  go 
to  one  of  these  meetings  I  write  a  letter  telling  them  why  I  can't 
come. 

Hughes:   Was  any  one  of  these  associations  that  you've  mentioned  more 

important  than  the  others  as  far  as  conveying  new  information  is 
concerned? 

Gerbode:   I  think  the  two  most  important  ones  are  certainly  the  American 
Association  for  Thoracic  Surgery  and  the  American  Surgical. 


205 


The  Society  of  Clinical  Surgery 


Gerbode:   The  Society  of  Clinical  Surgery  was  started  by  Harvey  Gushing  and 
some  of  the  Mayo  brothers  many  years  ago.   They  had  meetings  twice 
a  year.   They'd  go  to  the  various  clinics,  have  an  operative 
clinic,  a  discussion  of  operations,  and  a  clinical  session  where 
the  best  of  what  that  particular  university  department  or  clinic 
was  doing  [was  presented].   A  small  group  of  people  [were  members], 
ten  or  fifteen  originally.   Membership  in  that  society  has  gone 
up  to  perhaps  fifty  or  sixty.   They  have  a  meeting  once  a  year  now. 
The  meeting  is  usually  an  operative  session  in  the  morning  and  then 
a  sit-down  discussion  in  the  afternoon. 

Hughes:   Do  they  deign  to  include  West  Coast  institutions? 

Gerbode:   Oh  yes.   I've  been  a  member  for  many  years  and  they  have  had 
meetings  here  and  in  Los  Angeles. 

Hughes:    In  the  early  days  it  was  pretty  much  an  East  Coast  phenomenon,  was 
it  not? 

Gerbode:   Oh  yes.   In  the  early  days  it  was  entirely  East  Coast,  and  mostly 
New  England  and  Baltimore.   But  then  by  the  time  I  came  along  my 
chief,  Dr.  Holman,  was  a  member,  and  I  guess  maybe  Dr.  [Howard] 
Naffziger  at  the  University  of  California  was  a  member  too. 


Presidency  of  the  American  Association  for  Thoracic  Surgery 


Hughes:    Is  there  anything  significant  to  talk  about  in  connection  with  your 
presidency  of  the  American  Association  for  Thoracic  Surgery? 

Gerbode:   I  don't  think  so.   If  you're  president,  the  big  worry  is  that  you 
have  to  give  a  very  formal  paper.   That  bothers  people.   As  soon 
as  they  say  you're  going  to  be  president,  that  means  you  have  to 
start  thinking  about  what  you're  going  to  say.   [laughs] 

Hughes:   Which  is  on  a  research  topic? 

Gerbode:   It  can  be  anything  you  want.   Luckily  we  were  right  in  the  midst  of 
this  computerized  monitoring,  [so]  I  then  gave  my  paper  on 
computerized  monitoring  for  seriously  ill  patients,  which  was  a 
very  timely  thing  at  that  point . 


206 


Hughes : 
Gerbode: 


Hughes: 
Gerbode: 


Hughes : 
Gerbode: 

Hughes: 
Gerbode: 
Hughes : 

Gerbode : 


Hughes : 
Gerbode: 


Is  Chat  the  main  responsibility  of  the  president? 

No.  He  presides  at  the  council  meetings  and  during  the  scientific 
sessions.   He  gives  a  reception,  and  he  presides  at  the  annual 
dinner,  which  is  a  big  event.   He  has  a  chance  to  help  make  policy 
decisions  through  various  committees.   So  it's  a  fairly  important 
position. 

Policy  in  regard  to  the  association  itself? 

Yes,  whether  or  not  they're  emphasizing  a  certain  kind  of  work  more 
than  another.   In  this  society  there  had  been  a  tendency  to  shift 
everything  into  heart  surgery,  so  lung  surgery  suffered  as  a 
consequence.   So  they  tried  to  have  a  session  on  thoracic  non-cardiac 
surgery  as  well. 

Is  that  mainly  due  to  the  fact  that  the  cardiac  people  outnumber 
the  lung  people? 

Yes,  and  everybody  is  doing  cardiac  surgery,  and  they're  all  doing 
AC   [aortocoronary]  bypasses,  and  so  they  all  want  to  talk  about  it. 

How  old  is  this  society? 
It  was  founded  in  [1917]. 

Before  the  days  when  a  man  was  specializing  in  thoracic  surgery,  is 
that  not  true? 

Well,  there  were  a  few.  Locally  the  ones  who  were  founders  were 
Dr.  Leo  Eloesser,  Dr.  Harold  Brunn,  who  did  one  of  the  early  lung 
resections  in  the  United  States,  Evarts  Graham,  and  John  Alexander. 
These  are  all  men  who  were  pioneers  in  thoracic  surgery. 


You  said  locally — 

Locally  it  was  Leo  Eloesser  and  Brunn. 
founders  in  San  Francisco. 


Those  were  two  of  the  early 


The  Bay  Area  Vascular  Society 


Hughes:   I  was  wondering  about  the  Bay  Area  Vascular  Society. 


207 


Gerbode:   They  made  me  an  honorary  member  a  few  years  ago,  which  is  nice  to 
receive.   They  meet  about  once  a  month,  usually  in  a  hospital 
setting,  and  talk  about  any  new  ideas  they  have  or  new  contributions. 
It's  a  very  pleasant  organization  to  belong  to. 


The  International  Surgical  Society 


Gerbode:   To  me  the  most  important  society  outside  of  the  American  ones  which 
I  belong  to  is  the  International  Surgical  Society,  or  Societe 
Internationale  de  Chirurgie.   I  spent  many  years  in  that  society. 
I  first  heard  about  it  through  Evarts  Graham,  who  was  the  president 
of  it  at  one  point.   He  was  professor  of  surgery  at  Washington 
University,  St.  Louis.   He  found  that  this  society,  which  was 
dominated  entirely  by  Belgians,  was  so  confusing  and  difficult  to 
understand  that  it  was  very  frustrating  to  him.   For  example, 
keeping  records  of  payments  of  dues  [and  memberships  was]  done  in 
a  curious  way,  and  he  couldn't  really  ever  get  good  figures  for 
them.   Even  though  it  was  an  international  society,  they  had  absolutely 
no  democracy  in  electing  their  presidents.   The  same  family  of 
people  became  president  by  their  own  decision.   "Well,  I  guess  I'll 
be  president  for  another  four  years.   Then  I  don't  think  I  want  to 
be  president  after  that."  There  wasn't  any  nominating  committee  or 
anything  like  that.   It  was  just  sort  of  handed  around.   It  was 
just  terribly  irritating,  particularly  to  Americans.   We  don't 
like  that  kind  of  thing  very  much. 

[telephone  interruption] 
Hughes:   You  were  talking  about  the  International  Surgical  Society. 

Gerbode:   I  was  made  president  of  the  American  chapter  of  the  International 
Surgical  Society  and  then  got  on  the  program  committee  of  the 
International  Society.   So  I  went  to  Brussels  twice  a  year  to  work 
on  the  program  for  the  meeting  which  occurs  every  two  years.   I 
got  to  see  the  office  and  to  know  the  people  and  began  to  work  on 
the  problem  [of  the  society's  organization]. 

The  office  [was]  run  by  a  woman  who  had  been  there,  firmly 
established,  for  years.   She  really  ran  the  whole  thing  in  her  own 
way.   She  kept  track  of  who  paid  dues  [by  making]  little  dots  in  a 
book  beside  [members']  names.   If  they  paid  it  would  be  a  blue  dot, 
and  if  they  didn't  pay  it  was  a  red  dot,  or  something  like  that, 
which  was  a  terribly  curious  way  of  doing  it.   The  money  I  guess  got 
deposited  in  a  bank  in  Brussels.   We  never  quite  could  see  any 
balance  sheet,  although  a  Belgian  accounting  firm  went  over  the  books 


208 


Gerbode:  and  reported  to  us  annually  that  things  were  all  right.   However, 
members  in  many  countries  never  paid  their  dues,  and  they  weren't 
thrown  out.   But  the  Americans  paid  their  dues,  and  they  had  the 
biggest  membership ,  and  it  looked  to  me  as  though  the  Americans 
were  really  holding  the  whole  thing  together  in  many  respects. 
The  Russians  paid  their  dues  regularly,  though. 

Hughes:   Was  the  membership  worldwide? 

Gerbode:   All  over  the  world.   Virtually,  every  country  was  represented  and 
therefore  it  had  a  great  inherent  strength.   I  liked  the  idea. 
Through  that  society  and  going  to  the  meetings,  I  got  to  know  a 
great  many  people  all  over  the  world  and  made  some  very  good  friends. 
In  any  event,  I  finally  got  on  the  council  of  the  society  and  then 
I  began  to  work  on  how  they  elected  the  president,  and  finally  put 
over  the  idea  that  the  president  should  not  always  be  a  Belgian, 
should  not  always  be  more  or  less  self-appointed,  and  above  all  not 
a  member  of  the  same  family. 

Hughes:   Wasn't  this  rather  sticky? 

Gerbode:  This  was  rather  sticky.   They  didn't  like  me  for  suggesting  this. 
But  I  had  enough  support  from  the  Germans  and  some  of  the  French 
and  certainly  the  other  Americans  to  change  some  of  these  things. 

Hughes:   You  had  gone  around  before  the  confrontation? 

Gerbode:   I'd  talked  to  them  at  other  meetings  about  it.   Every  year  we'd 
have  a  meeting  of  the  American  chapter ,  and  these  things  were 
discussed  there,  too.   So  finally  we  managed  to  get  some  good 
presidents  elected  outside  of  Belgium,  and  to  take  the  secretaryship 
out  of  Brussels.   The  charter  had  said  that  the  secretary's  office 
should  always  be  in  Brussels.  Well,  finally  after  some  deft 
manipulation  I  got  the  bylaws  changed  so  that  the  secretary  could 
be  elsewhere.  We  finally  prevailed  upon  a  Swiss  by  the  name  of 
Martin  Algower  to  be  president.   He  volunteered  to  set  up  a  modern 
office  with  computerized  membership  cards  and  all  the  rest  of  it 
and  to  have  a  private  foundation  he  was  connected  with  subsidize 
the  society  for  three  or  four  years  to  the  tune  of  about  seventy-five 
thousand  dollars.   Then  with  this,  we  were  able  to  get  the  records 
out  of  Brussels,  inadequate  as  they  were,  and  modernize  them  and 
bring  them  up  to  date. 

Hughes:   How  had  the  society  existed  previously  if  much  of  the  membership 
didn't  pay  its  fees? 

Gerbode:   It  was  mainly  members  in  some  countries  who  didn't  pay. 


209 


Hughes:    So  there  was  money? 

Gerbode:   Oh,  there  was  an  adequate  amount  of  money,  because  as  time  went  on 
the  Americans  had  so  many  members  appointed  in  this  country,  that 
that  in  itself  amounted  to  quite  a  bit  of  money.   So  now  the 
secretaryship  is  in  Basel,  Switzerland  under  the  direction  of 
Martin  Algower.   It's  modernized  and  is  very  active  and  very  good. 
What  will  happen  in  the  long  run  I  don't  know,  but  at  least  it's 
on  firm  footing  for  the  time  being. 

Another  thing  which  bothered  some  of  us  a  great  deal  was  the 
publication  [of  the  papers  from  the  meeting]. 

II 

Gerbode:   [The  papers]  would  come  to  you  in  a  bound  volume  at  great  expense, 
and  always  so  late  that  you  more  or  less  had  forgotten  about  them. 
I  finally  got  the  [headquarters  office]  to  tell  me  how  much  this 
was  costing  them;  it  amounted  to  about  sixty  thousand  dollars.   A 
good  deal  of  the  money  that  was  being  paid  into  the  society  went  to 
subsidize  this  antediluvian  type  of  publication.   These  things  would 
arrive,  you'd  put  them  on  the  shelf  and  never  read  them,  or  they'd 
go  to  libraries,  and  nobody  would  ever  read  them  in  libraries  either. 

We  finally  got  the  society  to  consider  having  a  good  journal. 
Various  organizations  were  canvassed,  and  the  suggestion  was  made 
to  them,  "Would  you  like  to  publish  a  journal  that  would  be  the 
official  journal  of  the  society?"  The  papers  would  be  selected  for 
this  journal  not  only  from  the  meeting  but  from  other  contributions 
throughout  the  year.   Finally  Springer  Verlag,  the  German  [publishing] 
company,  said  that  they  would  be  willing  to  do  it  if  we  would 
subsidize  them  for  a  number  of  years.   We  got  enough  money  together 
to  subsidize  the  publication  for  two  or  three  years.   Springer 
Verlag  itself  lost  money,  and  is  still  I  think  losing  money.   But 
we  finally  have  the  World  Journal  of  Surgery,  and  it  is  very  good. 
Only  the  best  papers  from  the  meeting  get  into  it.   They  have  to 
go  through  an  editorial  committee  so  a  lot  of  the  bad  papers  never 
are  published,  which  is  good.   Then  they  have  developed  a  very  good 
way  of  presenting  symposia  on  important  aspects  of  surgery,  not 
related  to  that  meeting.   They  have  a  very  good  editorial  board 
from  all  over  the  world.   It's  turned  out  to  be  a  very  fine  journal. 

Hughes:    Is  the  criterion  excellence  or  is  there  also  an  attempt  to  get  a 
broad  representation? 

Gerbode:   We  try  to  get  everybody  to  participate  in  it,  but  they  don't  take 
papers  unless  they're  high  quality,  even  though  they  are  from  a 
country  that  doesn't  publish  very  much. 


210 


Hughes:   Why  did  the  society  grow  up  in  Belgium? 

Gerbode:   Belgium  [is]  a  neutral  country.   The  United  Nations  had  a  big  office 
there,  and  the  world  trade  organizations  were  all  there,  because 
it's  supposed  to  be  a  neutral  country  and  not  politically  very 
active. 

Hughes:   So  it  didn't  have  anything  to  do  with  the  quality  of  surgery? 

Gerbode:  No. 

[telephone  interruption] 

Hughes:   Dr.  Gerbode,  I  know  you've  always  been  interested  in  training  young 
people,  and  I  know  for  a  time  you  had  many  foreign  scholars  at  the 
institute.  Did  your  membership  in  the  International  Surgical 
Society  help  you  find  likely  candidates? 

Gerbode:  A  little  bit  perhaps,  but  I  guess  the  likely  candidates  came  out 

of  the  fact  that  we  had  a  very  active  unit  going  here  in  San  Francisco. 
It  was  well  recognized  throughout  the  world.   The  countries  who 
didn't  have  any  heart  surgery  going  [wanted]  to  send  their  young 
men  somewhere  in  the  States  to  have  them  trained  so  they  could  help 
their  programs  locally.  The  other  places  in  the  country,  the  Mayo 
Clinic  and  some  places  in  New  York,  were  active  in  those  early  days 
in  open  heart  surgery.   The  other  advantage  I  had,  I  gue.3s,  was  the 
fact  that  I  didn't  have  to  have  a  big  residency  program  going  for 
Americans.   That  was  because  we  didn't  have  an  approved  thoracic 
training  program  for  Americans. 

Hughes:  Was  that  because  it  was — ? 

Gerbode:  Because  of  the  university  not  being  here  anymore. 

Hughes:  And  they  didn't  count  the  University  of  the  Pacific? 

Gerbode:  No. 

Hughes:  It  was  too  far. 

Gerbode:   Yes.   It  wasn't  important  enough  for  them.   So  that  was  another 

reason  why  I've  selected  so  many  foreign  people  to  train.  But  I 
also  enjoyed  training  them  very  much,  because  they  were  the  cream 
of  the  crop  from  all  these  countries. 

But  coming  back  to  the  International  Surgical  Society,  the 
other  important  thing  we  had  to  work  on  was  the  fact  that  the  bureau 
in  Brussels  always  decided  themselves  where  the  next  meeting  would 


211 


Gerbode:   be  and  who  the  president  was  going  to  be.   We  felt  this  was  not 
being  very  democratic  and  we  had  to  change  that  as  well.   We  did 
this  through  the  council,  which  is  a  group  of  representatives  from 
various  countries.   The  council  finally  had  courage  enough  to  say 
no,  we're  not  going  to  let  you  decide  where  the  meeting  is  going  to 
be.   We're  going  to  decide.   This  was  a  little  traumatic  for  the 
bureau,  but  we  finally  put  it  through.   The  Belgians  are  very 
strange  people  in  many  ways.   They're  stubborn,  difficult  to  deal 
with.   I  guess  psychologically  they've  been  affected  by  being 
conquered  so  many  times  by  the  Germans. 

At  the  meeting  in  Kyoto  the  bureau  tried  to  push  through  its 
own  president.   I  didn't  think  its  selection  was  going  to  be  very 
good  at  all.   It  had  selected  the  person,  I  think,  because  it  was 
going  to  get  something  back  from  the  person  it  had  nominated,  in 
terms  of  membership,  or  paying  off  an  old  obligation  in  one  way  or 
another.   I  was  president  at  the  meeting  in  Kyoto.   They  nominated 
this  fellow  for  presidency,  and  then  I  had  a  little  group  of 
people  who  were  going  to  nominate  some  other  people  from  the  floor. 
I  said,  "The  nominations  are  now  open  from  the  floor,"  which  they 
had  never  heard  of  before.   They  just  said,  "We've  decided  the 
president  will  be  so-and-so,"  and  then  everybody  said  yes.   But  I 
said,  "We're  going  to  vote  on  this."  So  there  was  another 
nomination  from  the  floor.   Then  I  said,  "I  think  we  ought  to  have 
s'ome  discussion  of  these  candidates,"  which  had  never  been  heard  of 
before  either.   So  various  people  got  up  and  talked  about  the 
virtue  of  the  two  candidates,  and  so  forth  and  so  on.   Finally  the 
candidate  whose  name  had  been  submitted  from  the  floor  won  quite 
easily.   [The  candidate  who  didn't  win]  had  to  have  a  major 
operation  on  his  aorta  performed  about  three  or  four  months  after 
the  meeting,  and  he  died  afterwards.   So  he  wouldn't  have  been 
president  anyway.   It  was  too  bad.   He  was  a  nice  man,  but  not  a 
very  brilliant  person. 

Hughes:   Were  you  the  first  American  president? 

Gerbode:   No. 

Hughes:    Is  there  any  subdivision?   Surgery  is  a  big  field. 

Gerbode:   No.   There  has  been  a  conflict,  because  so  many  of  the  bright  young 
people  went  into  cardiac  surgery,  and  the  programs  are  a  lot  more 
exciting  in  cardiac  surgery  than  they  are  in  let's  say  gastrointestinal 
or  colon  surgery.   Hardly  anything  ever  comes  out  that's  very  new 
[in  these  fields].   So  the  vascular  people  got  kind  of  snooty  about 
it.   We  used  to  have  the  meetings  [of  the  International  Cardiovascular 
Society  and  the  International  Surgical  Society]  at  the  same  time  or 


212 


Gerbode:   sequentially.   The  vascular  people,  which  is  the  International 
Cardiovascular  Society,  for  which  I  was  president  of  the  North 
American  chapter  at  one  time,  decided  this  year  not  to  have  the 
meeting  with  the  International  Society  of  Surgery,  and  so  they're 
meeting  on  September  18,  [1983],  I  think  it  is,  in  Rio  de  Janeiro. 
But  I  have  a  feeling  they'll  come  back  again  to  the  sequential 
meeting  with  the  International  Surgical  Society,  because  although 
they  now  have  demonstrated  that  they  can  be  their  own  people  and 
all  that,  I  think  actually  it's  better  to  bring  all  the  surgeons 
together. 

Now,  two  other  societies  meanwhile  have  asked  to  have  joint 
meetings  with  the  International  Society.   There's  a  gastrointestinal 
group  and  an  endocrine  group  who  are  now  going  to  meet  with  the 
International  Society.   Then  there's  another  group  mainly  interested 
in  education  and  research  in  centers  in  the  world  that's  called  the 
Federation  Colleges.   They  always  meet  now  with  the  International 
Surgical  Society.   That's  a  good  idea,  too,  because  they  talk  about 
training  of  surgeons  and  basic  things  like  that. 

I  look  forward  to  this  meeting  in  Hamburg.   I  think  it's  going 
to  be  a  very  good  meeting.   It's  a  good  place  to  have  an  international 
meeting.   They  have  good  facilities,  good  hotels. 


Surgery  in  Various  Countries:   Comparisons 


Hughes:   When  you  get  into  the  higher  echelons  of  surgery,  is  there  much 
technical  difference,  from  nation  to  nation? 

Gerbode:  Yes,  I  think  there  is.   Some  of  the  countries  in  Eastern  Europe  are 
really  quite  poor  in  their  technical  ability,  and  that's  mainly 
because  their  training  methods  are  not  very  good  and  selection  of 
the  top  people  very  often  is  done  on  a  political  basis  rather  than 
on  skill.   For  example,  in  Yugoslavia  there's  one  professor  of 
surgery  whose  biggest  contribution  is  his  mouth.  He's  the  most 
outspoken,  loud-mouthed  surgeon  I  know.   He  talks  everybody  down 
wherever  he's  been.   But  actually  his  presentations  are  terrible. 

I'd  say  the  Germans  are  very  skilled.   Some  of  the  French  are 
very  skilled.   I  don't  know  very  much  about  many  of  the  centers  in 
France,  but  certainly  the  Parisian  surgeons  are  very  good.   I  think 
most  of  the  English  surgeons  are  quite  good,  especially  those  in 
medical  schools. 


213 


Hughes : 
Gerbode: 

Hughes: 
Gerbode: 


Hughes : 
Gerbode: 


Hughes : 
Gerbode : 


When  you  say  quite  good,  do  you  mean  in  a  technical  sense? 

Yes,  they  are  able  technically  and  they  understand  how  to  take  care 
of  a  sick  patient. 

Are  most  of  these  top  people  associated  with  a  research  institution 
as  well? 

Research  is  not  done  on  nearly  as  broad  a  basis  in  England  and 
Ireland  as  it  is  in  this  country.   The  Germans  are  increasing  their 
research  capabilities  a  good  deal  by  granting  money  from  their 
federated  treasury  to  medical  schools  and  institutions.  Also  the 
Germans  have  recognized  that  the  excellence  that  we  have  in  America 
has  really  come  from  the  great  support  of  the  National  Institutes 
of  Health  and  societies  like  the  Heart  Association  and  the  Cancer 
Society.   I  think  also  the  young  people  here  in  the  United  States 
who  wanted  to  go  on  in  academic  careers  found  that  if  they  published 
good  things,  their  academic  careers  would  be  pushed  forward.   So 
they're  all  trying  to  make  their  way  with  contributions  of  that 
kind. 

British  governmental  policy  has  not  been  favorable  to  medical  research? 

They  don't  have  as  much  money  in  their  allocations.   They  have 
barely  enough  money  to  keep  their  medical  institutions  going.   They 
found  that  a  national  health  service  cost  them  a  lot  more  money 
than  they  ever  expected,  and  that  it  isn't  very  good.   Actually, 
currently  the  fastest  growing  insurance  in  England  is  private 
medical  insurance.   People  have  found  that  by  paying  for  it  they 
get  better  care  and  they  can  select  their  own  doctors.   They  would 
rather  go  to  a  smaller  hospital  with  their  own  doctor  than  to  go 
to  a  big  teaching  hospital  and  not  know  who  is  going  to  take  care 
of  them.   The  backlog  in  the  big  teaching  hospitals  is  enormous. 
It's  unfortunate,  but  that's  the  way  it  is.   It  just  isn't  working 
out. 

Is  the  United  States  really  in  the  lead  in  most  fields  of  surgery? 

Oh  yes,  I  think  so.   Across  the  board,  I  think  there's  no  question 
about  it.   There  are  places  in  the  [world]  where  men  and 
institutions  have  emerged  in  a  very  great  way.   For  example, 
there  are  one  or  two  very  prominent  surgeons  in  China  who've  done 
an  enormous  job  in  cancer  of  the  esophagus.   They've  done  very  good 
work  and  they've  published  their  work,  and  it's  stood  up  very  well 
as  compared  with  other  countries.   For  example,  G.B.  Ong,  who  is 
the  professor  of  surgery  in  Hong  Kong,  has  a  remarkable  record  in 
major  surgery. 


214 


Hughes:   But  these  are  individual  exceptions. 
Gerbode:  Yes. 

Hughes:   Would  you  credit  the  leadership  of  the  United  States  in  surgery 
mainly  to  the  tie-in  with  research? 

Gerbode:   I  think  that's  one  [reason].   I  think  the  rewards  given  to  young 

people  who  have  made  contributions  are  so  worthy  that  they  try  to 
do  something  unusual,  they  try  to  make  a  contribution.   The  other 
thing  is,  we  have  residency  training  programs  in  our  country  which 
are  not  generally  accepted  elsewhere.   For  example,  in  Germany  a 
man  stays  in  training  for  years  and  years  and  years ,  which  is 
good  for  him  in  a  way.   He  becomes  very  skillful.   But  there  aren't 
many  trained  in  the  system  this  way. 

Hughes:   So  there's  a  sharp  pyramid. 
Gerbode:  Yes. 


The  Pan-Pacific  Surgical  Association 


Hughes:   Is  there  anything  particular  to  say  about  the  Pan-Pacific  Surgical 
Association? 

Gerbode:   The  Pan- Pacific  Surgical  Association  is  a  very  good  organization. 
I  started  going  to  their  meetings  because  I  was  going  to  the 
[Hawaiian]  Islands  quite  often  anyway,  and  it  was  great  fun  to  go 
down  there  to  a  meeting.   When  I  went  to  the  first  meeting  I  was 
really  quite  surprised  to  find  it  was  well  attended  by  Japanese, 
Chinese,  Australians,  New  Zealanders,  and  many  from  [other  parts  of] 
the  United  States.   Even  though  they  were  not  working  in  the  Pacific, 
they  liked  the  idea  of  going  to  the  Hawaiian  Islands  for  a  meeting. 
[Some]  of  the  presidents  have  come  from  the  eastern  part  of  the 
United  States.   That  was  done  deliberately  so  that  they  would 
encourage  memberships  in  the  mainland.   So  there  are  a  great  many 
members  all  over  the  United  States. 

Hughes:   Is  there  a  journal? 

Gerbode:   They  publish  a  journal  although  every  paper  is  not  published. 

The  best  papers  are  selected,  [as  in]  some  other  organizations. 


215 


The  Society  for  Vascular  Surgery 


Hughes:   We've  mentioned  the  Society  for  Vascular  Surgery.   You  were  president 
of  that  as  well. 

Gerbode:   The  Society  for  Vascular  Surgery  was  started  in  this  country  when 
vascular  surgery  got  to  be  a  pretty  recognized  field. 

Hughes:   After  the  war. 

Gerbode:   After  the  war.   I  was  very  active  and  always  went  to  the  meetings 
and  eventually  they  elected  me  president . 


The  International  Cardiovascular  Society 


Gerbode:   Harry  Shumaker  and  I  put  together  the  International  Cardiovascular, 
North  American  Chapter  because  some  of  the  elder  statesmen  said, 
"You  two  fellows  are  busy  in  the  field  and  know  all  the  vascular 
surgeons.   Why  don't  you  put  together  the  International  Cardiovascular, 
North  American  Chapter?"  So  we  just  sat  down  and  picked  out  the 
good  people  in  the  country  and  asked  them  if  they  would  like  to 
join.   They  all  joined,  so  then  they  had  a  good  chapter. 

Hughes:    Is  there  any  problem  with  having  so  many  surgical  societies? 

Gerbode:   Oh,  there  is  a  problem.   If  I  went  to  the  meetings  of  every  society 
I  belong  to,  I'd  be  in  meetings  all  the  time.   It's  bad  enough  as 
it  is  going  to  maybe  one  out  of  three  meetings.   I  haven't  been  to 
a  meeting  of  some  of  the  organizations  for  a  long  time.   The 
Halsted  Society,  for  example.   Luckily,  I 'm  a  senior  citizen  now, 
so  that  I'm  forgiven  if  I  don't  show  up  at  a  meeting. 

Hughes:    It  must  have  been  a  problem  when  your  career  was  so  pressing,  to 
find  time  for  these  meetings. 

Gerbode:   I'll  tell  you,  it  was  hard.   First  of  all,  I  tried  to  be  with  my 

family  some  of  the  time.   But  this  work  in  developing  heart  surgery 
was  very  demanding,  and  to  have  a  training  program  going,  a 
research  program  going,  and  try  to  devleop  the  field  of  cardiac 
surgery  was  very  hard  on  family  life.   I  think  my  wife  was  very 
brave  to  live  through  it.   It  was  hard  on  her,  I  can  tell  you.   I 
know  quite  a  few  families  which  really  fell  apart  because  the  men 
had  to  work  so  hard.   [One  problem  was]  that  you  had  to  go  back  to 


216 


Gerbode:  the  hospital  almost  every  night  to  check  on  the  patients.   Some  men 
don't  do  it.   But  if  you're  conscientious  you  do.   Or  you're  in 
touch  on  the  telephone,  which  means  that  you're  not  sitting  around 
enjoying  life;  you're  sitting  around  waiting  for  the  phone  to  ring. 

Hughes:   And  1  imagine  there  was  a  certain  tension  involved  when  the 
procedures  were  all  new. 

Gerbode:  Yes.  Also,  relative  to  the  societies,  if  you're  in  the  leading 

edge  of  a  new  speciality,  you're  very  anxious  to  make  contributions 
before  anybody  else.   So  you're  constantly  trying  to  do  something 
that  will  get  on  a  program,  and  probably  trying  to  do  it  before 
somebody  else  gets  on  the  program.   It's  very  competitive.   It's 
good  for  the  organization  itself  to  be  competitive  this  way.   So 
you  go  to  a  lot  of  meetings  and  you  try  to  present  your  material  as 
often  as  you  can. 

Hughes:   We  talked  earlier  about  free  interchange  of  information,  and  yet 
I  would  think  that  an  individual  would  have  certain  reservations, 
particularly  if  he  was  working  on  something  that  wasn't  quite 
ready  for  publication.  Would  you  really  be  quite  so  free  with 
information  at  that  stage? 

Gerbode:   I  think  you  would  certainly  hide  certain  things  that  were  really 

pretty  fresh  and  new  and  not  let  them  out  of  the  bag  too  soon .   But 
actually  most  people  know  what  you're  doing  anyway.   There's  so 
much  interchange,  visiting  around  in  laboratories  and  places,  that 
the  word  gets  around  that  you've  got  a  new  valve,  a  new  way  o:: 
doing  something. 

Some  men  in  the  biological  field  have  developed  a  reputation 
for  stealing  ideas.  I  know  one  very  famous  man  at  the  University 
of  California  who  liked  to  visit  other  laboratories  all  the  time, 
but  some  of  the  men  in  these  other  universities  would  lock  every 
thing  up  whenever  he  was  going  to  come  around,  otherwise  he'd  take 
the  idea  home  and  work  at  it  in  his  laboratory. 


The  American  Heart  Association 


Hughes:   You  had  quite  a  bit  of  money  over  the  years  coming  from  the  American 
Heart  Association,  didn't  you? 

Gerbode:   I  was  president  of  the  San  Francisco  Chapter  of  the  American  Heart 
Association.   But  the  best  thing  I  did  with  the  Heart  Association 
outside  of  spending  their  money  wisely,  I  thought,  was  to  get 


217 


Gerbode:   Mr.  Bramson  on  as  an  established  investigator  when  he  wasn't  an 

M.D.   As  I  mentioned  before,  he  was  the  first  pure  engineer  in  the 
country  to  become  an  established  investigator  and  he  was  paid 
a  small  stipend  from  the  AHA.   Now  it's  quite  accepted,  and  there 
are  Ph.D.s  and  others  who  are  not  M.D.s  who  are  supported  by  the 
Heart  Association,  and  their  research  is  supported  by  the  Heart 
Association. 

One  of  the  biggest  things  I  felt  that  we  did  in  our  unit  was 
to  bring  people  who  were  not  doctors  right  to  the  bedside  to  help 
with  clinical  problems.   [They  were]  engineers  and  Ph.D.s  and 
physiologists.   It's  amazing,  if  you  get  a  non-M.D.  looking  at  a 
problem  what  you  can  learn  and  discover.   Mr.  Bramson  didn't  know 
anything  about  biology  when  I  hired  him  to  work  with  our  research 
unit.   He  very  quickly  learned  all  the  basics  about  blood  and 
circulation.   He  did  all  the  mathematics  connected  with  it.   He 
studied  and  learned  about  physiology  and  blood.   He  became  a  very 
successful  biomedical  engineer. 

Hughes:   Probably  this  interdisciplinary  approach  to  medical  problems  is 
one  of  the  key  features  of  modern  medicine,  wouldn't  you  say? 

Gerbode:  Yes,  and  I'm  very  proud  of  our  unit  because  we  were  among  the 
very  first  to  bring  people  who  were  not  medical  people  to  the 
bedside. 

Hughes:   That  whole  episode  with  IBM  and  computer  monitoring  is  another 
example. 

Gerbode:   Absolutely.   You  see,  IBM  sent  out  three  very  top-grade  Ph.D.s  to 
work  with  us.   They  watched  all  the  signals  as  they  came  into  the 
computer,  and  pretty  soon  they  could  tell  when  things  were  not 
going  well  with  a  patient  just  by  looking  at  the  signals. 


The  California  Academy  of  Medicine 


Hughes:   You  were  president  of  the  California  Academy  of  Medicine  as  well. 

Gerbode:   The  California  Academy  of  Medicine  is  an  old  California  institution. 
Originally  it  was  the  licensing  organization  for  the  State  of 
California  before  we  had  a  State  Board  of  Medical  Examiners  or 
whatever  they  call  it  now.   It's  kind  of  a  prestigious  organization. 
They  have  a  meeting  about  once  a  month  [with]  a  big  dinner  and  a 
guest  speaker,  somebody  well  known  in  the  world.   The  Family  Club 


218 


Gerbode:   is  where  they  previously  had  the  cocktail  party  and  dinner,  and 
then  they'd  roll  down  the  hill  to  the  St.  Francis  Hotel,  where 
they'd  have  the  lecture.   By  that  time  everybody  was  so  spiff icated 
that  most  of  them  wanted  to  go  to  sleep.   Now  they  have  the  lecture 
first,  and  then  the  dinner. 

fi 

Gerbode:   [The  dress  is]  black  tie. 

Hughes:  Do  they  publish  California  Medicine? 

Gerbode:  No.  They  don't  publish  anything. 

Hughes:  So  that  particular  association  is  more  social  than — 

Gerbode:  Yes.   It's  social,  a  little  bit  prestigious,  and  old  and  venerable. 

Hughes:   There  are  other  associations  on  this  list.  Do  you  want  me  to  read 
them? 

Gerbode:  Well,  being  a  member  of  some  of  these  societies  gets  to  be  like 
the  domino  principle.   If  you're  made  a  member  of  one  particular 
organization,  then  it's  almost  sure  that  you're  going  to  be  asked 
to  be  a  member  of  another.  And  you  never  know  how  this  happens. 


Honors* 


Gerbode:   I  think  probably  the  most  gratifying  thing  to  me  in  looking  back 
at  my  career  is  the  fact  that  I  got  some  honorary  degrees.  These 
are  things  that  aren't  gained  by  political  access  to  universities. 
As  a  medical  student  I  would  have  thought  perhaps  that  getting  an 
academic  degree  in  another  famous  university  was  going  to  be  beyond 
me.   So  when  I  started  getting  some  honorary  degrees  I  was 
enormously  pleased.   My  wife  was  enormously  pleased,  too,  because 
a  wife  really  shares  in  these  things,  you  know.   For  example,  the 
eulogy  [for]  the  degree  from  the  National  University  of  Ireland 
was  read  in  Latin  by  [Eamon]  De  Valera  himself.   It  was  a  very 
impressive  event  in  my  life. 

Hughes:   Do  you  know  in  each  case  why  you  were  awarded  the  degree? 


*See  the  session  recorded  on  6/13/84, 
discussion  of  honors. 


pp.  412-415,  for  further 


219 


Master  of  Surgery  (Honoris  Causa),  The  National  University 
of  Ireland,  1961 


Gerbode:   I  think  the  reason  that  I  was  awarded  the  degree  in  Ireland  was  the 
fact  that  I  set  up  what  you  might  call  an  international  training 
center  for  cardiovascular  surgery.   In  other  words,  I  welcomed 
people  from  all  over  the  world  and  whenever  possible  taught  them 
something.   I  trained  many  people  from  other  countries,  in  addition 
to  doing  pretty  good  research. 

Hughes:   Had  the  Irish  been  particularly  well  represented? 

Gerbode:   No,  not  very  well  represented. 

Hughes:   Are  these  honorary  degrees  awarded  by  a  committee? 


M.D.  (Honoris  Causa),  Uppsala  University,  1965 


Gerbode:   Yes. 

I  was  really  quite  surprised  at  the  honor  from  Uppsala 
University  because  that  is  probably  one  of  the  two  or  three  most 
prestigious  universities  in  [Europe] .  When  they  read  the  reasons  for 
giving  me  the  degree,  it  was  mainly  about  my  experimental  surgery 
on  animals  some  years  before.   They  dug  this  up  and  said  [you  were] 
among  the  first  to  do  these  things. 

Hughes:   Are  the  Swedish  research  oriented? 

Gerbode:   They  are  very  research  oriented,  and  they  do  good  work. 

Hughes:   That  might  be  some  of  the  reason. 

Gerbode:   Yes,  that's  another  reason.   They  do  excellent  work  and  they've 
made  notable  contributions,  and  still  do,  and  in  a  country  where 
medicine  is  probably  more  socialized  than  any  other  country  outside 
of  Russia.   For  example,  a  [Swedish]  surgeon  who  does  a  case  let's 
say  on  a  Saudi  Arabian  prince  can  only  collect  five  dollars  for 
it.   He's  supposed  to  do  it  for  nothing  really.   The  man  has  to  pay 
for  his  hospitalization,  but  [the  surgeon]  can't  accept  a  fee.   I 
imagine  that  some  of  these  very  wealthy  people  arrange  somehow  to 
compensate  the  surgeon. 


220 


Hughes:   So  the  Swedish  surgeon  is  on  strict  salary? 

Gerbode:  Oh  yes,  and  he's  limited  in  the  amount  of  money  he  can  collect 

from  private  patients.   Many  of  them  leave  the  country  if  they  have 
a  chance  to  go  somewhere  else.   The  same  as  the  English. 

Hughes:   Within  the  country  concerned,  is  the  salary  sufficient  to  be  an 
incentive  to  enter  that  field? 

Gerbode:   I  guess  it's  comparative.  None  of  the  salaries  anywhere  in  Sweden 
are  high,  so  everybody  is  reasonably  poor.   If  you're  a  professor 
you  can  have  a  small  house,  maybe  even  a  tiny  house  at  the  beach 
somewhere.   Private  property  still  exists,  so  that's  an  advantage. 


Honorary  Fellow  of  the  Royal  Colleges  of  Surgeons  of  England  and 
Edinburgh,  1969  and  1975 


Gerbode:   The  Royal  College  of  Surgeons  in  England  made  me  a  member.   That's 
an  honor,  as  did  the  Royal  College  of  Surgeons  in  Edinburgh,  that's 
an  honor,  too.   But  I  think  that's  given  mainly  on  the  work  you've 
been  doing,  the  publications  you  made  and  the  people  you've  trained 
and  that  sort  of  thing.   I  guess  England  and  Scotland  were  happy 
to  honor  me  because  I'd  trained  about  twelve  surgeons  in  England  and 
I'd  been  to  many  meetings  and  I  have  lots  of  friends.   Certainly 
that  helps  in  getting  through  a  committee.   You  don't  propose 
yourself.  Having  friends  anywhere  in  the  world  I  guess  is  a  help. 


M.D.  (Honoris  Causa),  University  of  Thessaloniki,  1964 


Hughes:   What  about  the  honorary  M.D.  from  the  University  of  Thessaloniki? 

Gerbode:  That  came  largely  because  I  had  two  or  three  very  close  friends 

high  up  in  the  university.   I  had  helped  to  train  a  couple  of  Greek 
surgeons,  [and]  I'd  been  to  Greece  a  number  of  times  and  given  some 
lectures  at  the  University  of  Thessaloniki.   To  get  a  degree  there 
is  a  very  ancient  ritual ,  because  you  wear  a  long  robe  that  looks 
like  a  monk's  robe  and  has  a  picture  of  an  angel  on  the  side.   The 
hat  looks  like  a  cardinal's  hat. 


221 


Hughes: 
Gerbode: 


Hughes: 
Gerbode: 
Hughes: 
Gerbode: 


The  Rene  Leriche  Prize,  International  Society  of  Surgery,  1973 

What  about  the  Rene  Leriche  Prize? 

Every  year  the  International  Surgical  Society  makes  an  award  to  an 
individual  who  has  made  contributions  in  cardiac  or  vascular  surgery. 
The  selection  is  made  by  a  committee.   One  year  they  gave  it  to 
me. 

On  the  basis  of  what  aspect  of  your  work? 

I  think  all  the  publications  in  cardiac  and  vascular  surgery. 

Who  was  Rene  Leriche? 

Rene  Leriche  was  a  famous  French  surgeon  who  did  not  grow  up  in 
Paris.   This  became  a  disadvantage  for  him  later  in  life,  because 
in  order  to  become  a  professor  or  the  head  of  a  department  in  Paris 
you  have  to  really  grow  up  in  the  system  in  Paris.   When  some  people 
wanted  him  to  become  chairman  of  the  department  in  Paris,  it  was 
stopped,  I  think,  on  the  basis  that  he  came  from  Strasbourg  or 
somewhere  outside  of  Paris.   But  he  wrote  very  good  papers  on 
vascular  disease. 

There  is  one  syndrome  called  the  Leriche  Syndrome,  and  that  is 
thrombotic  and  arteriosclerotic  occlusion  of  the  abdominal  aorta. 
[It]  occurs  mainly  in  middle  aged  people,  middle  aged  men  more  than 
women,  although  women  can  get  it.   The  basis  is  mainly  arteriosclerosis 
of  the  abdominal  aorta.   The  syndrome  is  associated  with  weakness, 
tiredness  and  coldness  of  the  legs  and  reduced  sexual  capacity 
because  the  blood  suppy  to  the  genital  organs  is  decreased  as  well 
as  to  the  legs.   So  men  cannot  have  a  proper  erection  and  can't 
sustain  an  erection.   The  nerves  to  the  genital  organs  are  affected, 
too,  from  ischemia. 

[interruption] 


Alexis  Carrel 


Hughes:   Talking  about  Leriche  made  me  think  of  Alexis  Carrel,  who  had  done 
some  very  early  vascular  work  in  France  and  then  later  at  the 
Rockefeller  Institute.   Was  there  any  association  between  them? 


Gerbode:   No. 


222 


Hughes:   Was  it  just  coincidence  that  those  two  pioneers  were  French? 

Gerbode:   I  think  Alexis  Carrel  really  didn't  orginate  the  vascular  surgery 

techniques  that  he  applied  at  the  Rockefeller  Institute.   I  think  he 
saw  other  French  surgeons  using  them.   But  anyway,  he  transplanted 
organs  and  kept  them  alive  with  vascular  suture.   For  example,  he 
transplanted  a  heart  into  the  neck  of  a  dog  and  it  stayed  alive  for 
a  while.   He  demonstrated  that  you  could  sew  arteries  together  and 
that  they  would  heal.   This  work  plus  a  number  of  other  things  such 
as  tissue  culture  techniques  is  what  gave  him  a  Nobel  Prize. 

Now,  the  curious  thing  is,  you  see,  that  this  was  in  [1912]. 
It  really  took  one  whole  generation  for  this  concept  to  be  applied 
on  a  broad  basis.   This  is  generally  true  that  it  takes  twenty 
years  for  an  idea  to  become  widely  accepted  and  adopted.   It  was 
certainly  true  of  the  heart-lung  machine  that  Jack  Gibbon  started 
working  on  before  the  war  in  Boston.   It  took  twenty  years  for  that 
to  get  on  the  road. 

Hughes:   Is  it  mainly  changing  people's  points  of  view? 

Gerbode:   I  don't  really  know  what  the  reason  is.  As  somebody  said,  the 

future  belongs  to  the  people  who  see  things  around  them  that  can  be 
utilized  right  away.   The  thing  is  we  don't  really  accept  them  or 
use  them,  but  they're  all  around  us. 


The  British  Order  of  St.  John  of  Jerusalem,  1956;  Knight,  1978 


Hughes : 


Gerbode: 


I'm  looking  at  the  honors  again. 
Jerusalem. 


The  British  Order  of  St.  John  of 


This  is  the  oldest  order  of  chivalry  in  the  British  Empire  and  goes 
back  to  the  Knights  of  Malta.   The  Knights  of  Malta  were  the  ones 
who  fought  against  the  infidels  in  the  Middle  East.   They  were 
trying  to  get  the  Holy  Grail  out  of  the  Middle  East  and  they  were 
also  fighting  against  the  Mohammedans.   It  was  a  big  thing  for  a 
wealthy  young  man  in  England  or  Germany  or  France  or  Italy  to  become 
a  knight  and  go  and  fight  this  war  against  the  non-Christians.  The 
Knights  of  Malta  were  from  all  these  various  countries.   It  was 
mainly  a  Catholic  organization.  Henry  VIII  stopped  the  Catholicism, 
including  the  English  chapter  of  the  Knights  of  Malta.   There  are 
Knights  of  Malta  in  France,  Italy  and  Germany.   Finally  the  British 
reestablished  the  Knights  of  Malta  on  a  non-Catholic  basis.   It 


223 


Gerbode:   was  more  or  less  put  into  the  hands  of  the  Church  of  England.   So 
there  is  an  association  between  the  various  countries  that  have 
the  Knights  of  Malta,  but  it's  a  rather  loose  association. 

They  decided  some  many  years  ago  to  have  an  American  chapter. 
They  had  ones  in  Canada  and  Australia,  too.   They  first  make  you  a 
brother  officer,  which  is  the  lowest  in  the  echelon,  and  then 
finally  you  get  elevated  to  something  else,  and  then  if  you're  a 
very,  very  good  boy  or  good  girl  you  become  a  knight.   The  women 
become  dames. 

Hughes:    Is  it  for  any  good  work  in  any  field  of  endeavor? 

Gerbode:   I  think  in  any  field  of  endeavor,  poetry,  business,  diplomacy, 

medicine,  science.   Anyway,  I  was  made  a  brother  officer  in  New  York 

about  ten  years  ago.   You  see  the  big  [emblem]  [referring  to  a 
photograph]  on  the  sleeve? 

Hughes:   Yes.   That's  impressive. 

Gerbode:   Four  years  ago  they  made  me  a  knight  here.   They  sent  out  the 

head  of  the  order  from  England  to  go  through  the  formalities  with 
the  sword  and  the  robes .   In  northern  California  I  guess  there  are 
three  or  four  other  knights. 

They  have  an  annual  meeting  in  London  which  is  quite  an  affair. 
You  meet  in  the  Old  Priory  Church  and  have  a  high  Church  of  England 
ceremony.   Then  you  have  a  typical  English  breakfast  afterwards. 
Then  you  go  to  the  Town  Hall  in  London.   There  they  discuss  what 
the  various  chapters  have  done  throughout  the  world.   They  maintain 
an  ophthalmic  hospital  in  Jerusalem,  which  is  a  very  good  one. 
Then  they  all  go  to  St.  Paul's  Cathedral.   You  line  up  in  the  order 
of  the  degree  of  your  appointment.   The  English  and  Scotch  knights 
are  in  the  front  of  the  procession.   The  other  knights  are  behind 
them,  depending  on  the  country  they're  from  and  whether  they're 
knights  of  English  descent  or  not. 

They  have  silver  and  gold  robes,  and  the  gold  robes  with  the 
golden  insignia  mean  that  your  family  came  from  England  or  Scotland. 
The  silver  ones  mean  that  your  family  did  not  come  from  England  or 
Scotland.   I  could  get  in  on  the  gold  thing  if  I  really  wanted  to, 
because  I  had  an  English  grandmother,  but  I  don't  think  it's  worth 
going  through  the  nonsense. 

At  any  rate,  everybody  lines  up  in  St.  Paul's  Cathedral.   The 
order  runs  the  ambulance  service  in  England.   They're  always  out  in 
mass  quantities  for  parades  and  coronations,  and  they  pick  up  all 


Gerbode : 


Hughes: 


224 


the  fainting  people  on  the  street,  and  they  maintain  law  and  order. 
They  train  people  in  ambulance  services  and  first  aid.   They  do  a 
really  good  job.   Many  members  are  present  at  this  annual  meeting 
in  London.  Then  the  most  exciting  thing  is  seeing  all  the  little 
children  who  are  junior  members  and  who  are  taking  first  aid.   They 
have  uniforms,  like  Girl  Scouts,  and  they're  all  in  the  back  of 
the  church,  their  eyes  fairly  popping  out  of  their  heads  to  see  all 
these  berobed  gentlemen  with  all  these  insignia.   They  love  it. 


And  you  do ,  too . 
dearest? 


[laughter]   Which  of  these  many  honors  do  you  hold 


Gerbode:   I  guess  I  like  the  English  ones  the  best  because  I've  spent  so  much 
time  there  and  have  so  many  friends  there. 


Service  on  Editorial  Boards//// 
[Interview  9:   September  19,  1983] 


Hughes:   Dr.  Gerbode,  you  are  on  several  editorial  boards,  and  perhaps  I 

should  read  them  for  the  record.   The  Annals  of  Surgery,  the  Review 
of  Surgery,  the  Annales  de  Surgerie  Thoracique  et  Cardio-vasculaire , 
the  Journal  of  Cardiovascular  Surgery,  and  Surgery  in  Italy.   Can 
you  tell  me  how  those  appointments  came  about? 

Gerbode:   I  think  the  most  important  one  on  the  list  is  the  Annals  of  Surgery. 
I  was  appointed  to  the  editorial  board  by  John  Gibbon,  who  was  a 
friend  of  mine  and  also  was  the  creator  of  the  first  heart-lung 
machine.   Being  on  an  editorial  board  means  that  you  review  and 
criticize  manuscripts  before  they're  published  and  vote  in  favor 
or  not  in  favor  of  having  them  published.   Sometimes  they're 
reviewed  and  then  sent  back  for  revision.  With  regard  to  the  Annals 
editorial  board,  I  suppose  on  an  average  we  reviewed  about  two  or 
three  manuscripts  a  week.  Now  the  load  is  less  because  we  have  a 
larger  board,  and  perhaps  they're  taking  some  pity  on  me  and  not 
sending  me  as  many  as  they  used  to.   But  in  any  event,  it's  been 
very  interesting,  because  you  really  have  to  know  the  field  pretty 
well.   Sometimes  you  have  to  look  up  the  literature  to  confirm 
whether  the  new  manuscript  is  really  contributing  anything  [new]. 
Knowing  the  people  in  various  academic  centers  is  important,  too, 
because  if  the  author  is  a  reliable  person,  it's  very  likely  that 
what  he's  written  is  going  to  be  reliable. 

We  have  an  annual  meeting  of  the  Annals  of  Surgery  during  the 
meeting  of  the  American  Surgical  Association.  Usually  a  luncheon  is 
put  on  by  the  publishers,  which  is  Lippincott  and  Company,  and  it's 
very  well  attended,  and  a  nice  event.   I've  always  brought  up  the 


225 


Gerbode:   rather  mean  subject  of  Lippincott  Company  not  making  a  contribution 
to  the  American  Surgical  Association  for  a  fellowship  or  some  sort 
of  reward,  because  I  know  they  make  a  fair  amount  of  money  from 
that  journal,  and  none  of  the  editors  are  paid  anything,  nor  do 
they  want  to  be  paid.   But  some  of  the  other  organizations,  like 
the  American  Association  for  Thoracic  Surgery,  publishes  in  the 
Journal  of  Thoracic  and  Cardiovascular  Surgery,  which  is  owned  by 
another  company.   They  give  the  AATS  a  fairly  large  contribution 
every  year,  sometimes  as  much  as  fifty  thousand  dollars.   I  know 
that  Lippincott  could  easily  match  that  if  they  wanted  to,  but  thejr 
never  have.   I  guess  I  shouldn't  bring  this  up  any  more  at  meetings, 
because  it  makes  me  rather  unpopular  with  the  publishers.   I 
don't  think  any  of  the  editors  want  any  money,  but  they  would  like 
to  have  some  contribution  to  education  or  fellowships  or  something 
like  that. 

Hughes:   Do  you  remember  when  the  Annals  was  founded? 

Gerbode:   The  Annals  of  Surgery  has  been  founded  for  probably  a  hundred  years. 

Hughes:    Is  an  editor  chosen  on  the  basis  of  his  prominence  in  the  field? 

Gerbode:   I  think  he's  chosen  because  people  know  he  is  a  conscientious 

person  and  is  knowledgeable  about  surgery  in  general  and  about 
his  own  specialty.  But  he's  also  known  for  being  punctual  and 
doing  a  good  job  in  various  contexts. 

[interruption] 

Gerbode:   Some  of  the  other  boards  I've  been  on  don't  require  very  much  work. 
Periodically  a  manuscript  will  come  frora  the  chief  editor  for 
review.   It's  usually  something  which  is  slightly  controversial, 
and  then  an  editor,  such  as  I've  been,  would  be  an  arbiter  between 
the  various  positions.   It's  been  interesting  to  do  these  jobs,  and 
it's  nice  to  read  material  before  it's  in  print,  too. 

Hughes:   Does  the  editor  send  you  papers  that  are:  roughly  in  your  field? 

Gerbode:   Sometimes,  but  when  you're  chosen  to  be  one  of  these  editors, 
you're  supposed  to  be  knowledgeable  about  the  whole  field  of 
surgery,  so  the  bulk  of  material  is  general  surgery.   Some  specialty 
work  comes  through. 

Hughes:   What  is  the  exact  procedure? 

Gerbode:   Usually  the  paper  is  sent  to  two  or  three  sub-editors,  and  each  one 
reads  the  paper,  makes  comments,  and  advises  the  main  editor  whether 
or  not  he  thinks  it  should  be  published,  and  gives  it  a  rating  from 


226 


Gerbode:   one  to  five.   Sometimes  you  can  suggest  that  something  be  published 
immediately,  because  it's  so  good  and  so  pertinent.   So  you  can 
write  a  priority  publishing  note  on  a  manuscript,  which  means  they'll 
probably  turn  it  out  in  the  next  issue.   Sometimes  manuscripts  get 
bounced  around  between  editors ,  because  they  want  to  review  and 
revise  them,  and  sometimes  a  sub-editor  will  say  he  can't  really 
decide  whether  to  have  it  published  or  not,  and  he'll  leave  it  up 
to  the  main  editor  to  decide. 

Hughes:   How  is  consensus  reached  amongst  the  sub-editors? 

Gerbode:   The  main  editor  will  look  over  the  criticisms  and  remarks  of  the 
sub-editors,  and  make  up  his  own  mind.   It's  curious  how  close 
the  agreements  usually  are.  We  get  the  comments  back  from 
everything  we've  reviewed,  and  it's  very  common  to  see  that  all 
the  sub-editors  will  say  the  same  thing  about  the  paper. 

Hughes:   Is  there  much  difference  in  outlook  amongst  these  various  journals? 

Gerbode:   I  think  there's  prestige  connected  with  publishing  in  some  of  these 
journals.   Annals  of  Surgery  has  a  lot  of  prestige,  because  it's 
been  so  good  and  [is]  so  old,  being  founded  in  1885.   So  if  somebody 
who  has  something  they  want  to  publish,  and  have  it  be  presented 
to  the  general  surgical  public  in  a  very  flattering  way,  he  would 
try  to  get  it  published  in  Annals .   It's  very  easy  to  publish  in 
some  journals,  and  very  hard  to  publish  in  others. 

Hughes:   So  Annals  is — 

Gerbode:   It's  one  of  the  very  best.   The  Journal  of  Surgery  is  very  good,  too. 
We  have  a  new  journal  called  the  World  Journal  of  Surgery,  which 
some  of  us  got  started  with  the  International  Surgical  Society.* 
That's  turning  out  to  be  quite  a  good  journal,  too. 

Hughes:   You're  not  connected  with  the  editing  of  that  particular  journal? 
Gerbode:  No,  I'm  not. 

Hughes:   Is  there  a  story  behind  the  appointments  to  the  other  journals  that 
I  mentioned? 

Gerbode:   I  don't  think  so.   Some  of  these  appointments  are  made  on  a  regionel 
basis.   In  other  words,  they  try  to  have  editors  in  various  parts 
of  the  country.   I  guess  I've  been  appointed  in  some  instances 
because  I  live  in  San  Francisco  when  they  wanted  to  have  a  West 
Coast  editor  or  a  northern  California  editor. 


*See  discussion  on  p.  209. 


227 


Affiliations  with  Medical  Institutions  in  the  Bay  Area 


Hughes:   Hospital  affiliations. 

Gerbode:   I've  not  tried  to  be  on  a  lot  of  hospital  staffs,  because  I  never 
have  liked  operating  in  a  number  of  different  hospitals.   I  have 
really  only  operated  in  two  private  hospitals,  Children's  Hospital 
and  the  old  Stanford  Hospital,  which  is  now  Presbyterian.   I  have 
[also]  operated  quite  a  lot  at  the  Oakland  Naval  Hospital  and 
Letterman  Army  in  San  Francisco. 

Hughes:   Why  don't  you  like  to  operate  in  other  hospitals? 

Gerbode:   I  don't  like  to  operate  on  a  patient  and  not  be  able  to  see  the 
patient  the  same  day  or  follow  the  patient  closely.  The  big 
advantage  in  operating  in  the  old  Stanford  Hospital  was  that  I  was 
there  all  day  long,  so  if  I  operated  upon  somebody,  I  could  go  see 
them  quickly  and  easily.   If  you  have  an  office  downtown  and 
something  happens  with  your  patient  in  a  hospital,  then  you  have  to 
get  somebody  else  to  look  in  quickly  or  hop  in  a  car  and  try  to 
get  there  yourself.   I've  never  liked  that  very  much. 

Hughes:   So  you'd  really  rather  follow  a  patient  through  all  the  way  in 
your  own  hospital? 


Children's  Hospital,  San  Francisco 


Gerbode:   Yes.   I  did  some  work  at  Children's  Hospital,  because  they  wanted 

to  start  a  heart  program.   This  was  particularly  true  when  Dr.  Holman 
retired  from  the  chair  and  wanted  to  get  out  of  Stanford  Hospital  and 
do  some  closed  heart  surgery  at  Children's  Hospital.   I  helped  him 
get  started  by  getting  instruments  for  them  and  more  or  less 
telling  them  what  was  required  to  do  the  work.   I  did  a  few  cases 
over  there,  too.   But  my  main  affiliation  always  has  been  with 
the  old  Stanford  Hospital. 


Oak  Knoll  Naval  Hospital,  Oakland 


Gerbode:   I  operated  at  the  Oak  Knoll  Naval  Hospital,  particularly  during  the 
Korean  War.   They  had  a  lot  of  casualties  coming  back,  particularly 
among  the  Marines,  and  I  went  over  there  at  least  once  a  week  and 


228 


Gerbode:   helped  the  chief  surgeons  operate  on  some  of  those  patients.  Some 
were  vascular  cases  and  some  were  chest  cases.   And  I  rather  liked 
that ,  because  I  felt  that  I  was  needed  and  I  could  make  a 
contribution. 

Hughes:   Does  the  surgical  staff  in  that  case  welcome  you  with  open  arms? 

Gerbode:  Oh  yes.   They  like  to  have  a  civilian  consultant  come  in.   I  did 

the  same  thing  later  at  Letterman  Army  Hospital.  When  they  wanted 
to  start  a  vascular  and  thoracic  program,  I  was  one  of  their 
consultants,  and  so  I  spent  a  lot  of  time  with  their  chief  surgeons, 
getting  them  started  in  these  various  procedures,  helping  them  do 
them.   The  army  appreciated  this  very  much,  and  for  that  reason, 
and  perhaps  some  other  reasons,  they  gave  me  a  Distinguished 
Civilian  Service  Award.   They  credited  me  with  getting  their 
thoracic  surgery  program  started.   The  other  person  who  helped  a 
lot  was  Paul  Samson  from  Oakland.   The  two  of  us  really  put  together 
their  thoracic  and  cardiovascular  program. 


The  University  of  California,  San  Francisco 


Hughes: 


Gerbode: 


Hughes: 
Gerbode : 


In  1965  you  became  an  associate  surgeon  at  UCSF. 
something  about  that  appointment? 


Could  you  say 


When  Stanford  decided  to  move,  which  was  1959,  we  had  a  very 
vigorous  open  heart  surgical  team  going,  and  were  making  pretty  good 
contributions.   There  were  several  hospitals  and  groups  in  the 
Bay  Area  who  thought  maybe  the  old  Stanford  campus  [in  San  Francisco] 
would  be  closed.   So  they  offered  me  and  my  unit  an  opportunity  to 
move.   Several  delegations  from  UC  San  Francisco  came  to  see  me 
about  making  me  a  professor  there  and  giving  me  the  opportunity  to 
run  their  heart  program. 

Did  they  not  have  much  of  a  heart  program  at  that  stage? 

They  had  one,  which  I  won't  mention  too  much  about  that,  but  they 
were  not  particularly  satisfied  with  it.   I  don't  know  whether  they 
were  justified  in  their  position  or  not.   But  that  was  why  they 
came  to  see  me. 

I  also  had  a  delegation  from  Mt.  Zion  Hospital  with  the  same 
idea  in  mind,  and  also  from  Children's  Hospital.   The  Children's 
Hospital  approach  was  rather  funny,  because  before  they  asked  me  to 
become  head  of  their  open  heart  surgery  program,  the  trustees  had 


229 


Gerbode:   decided  that  we  would  give  our  obstetrical  service  and  pediatric 
service  entirely  to  Children's  Hospital,  and  they  would  send  all 
their  heart  patients  to  us.   This  was  a  fair  trade,  because  they 
didn't  have  any  heart  program  that  amounted  to  anything,  although 
they  tried  later,  rather  unsuccessfully,  to  get  one  going.   But  a 
few  days  after  the  trustees  had  decided  this,  the  chief  of  staff, 
whose  name  I  won't  mention,  called  on  me  at  home,  wanted  to  know 
if  I  would  come  and  start  a  heart  program  at  Children's  Hospital, 
entirely  ignoring  the  decision  of  the  trustees. 

Hughes:   That's  interesting. 

Gerbode:   Well,  it  is.   It's  kind  of  funny  that  they  thought,  well,  it's 
nice  for  the  trustees  to  make  these  decisions,  but  we  don't 
necessarily  have  to  follow  their  suggestions  or  decisions. 

Hughes:   Did  you  look  twice  at  any  of  these? 

Gerbode:   No,  I  didn't.   If  I'd  gone  to  UC,  I  would  have  gone  into  a  hornet's 

nest.   It's  such  a  big  campus,  and  there  are  so  many  forces  that  play 
up  there,  and  I  knew  so  many  people  personally,  that  I  would  have 
had  a  hard  time  cleaning  house  and  getting  anything  set  correctly, 
and  I  didn't  want  to  do  that. 

Hughes:   Did  the  various  contingents  that  came  to  you  from  UC  imply  that 
there  was  considerable  division  within  that  department? 

Gerbode:   Yes.   They  weren't  satisfied  with  the  way  it  was  going.   I  guess 
they  wanted  to  have  somebody  come  in  who  could  make  decisions  and 
push  it  forward.   I  could  have  done  it,  but  I  would  have  made 
enemies,  too. 

The  same  thing  happened,  of  course,  at  Stanford.   They  sent 
several  delegations  to  get  me  to  move  to  Palo  Alto,  either  to  be 
professor  of  surgery  in  the  department  or  a  chief  of  cardiovascular 
surgery,  or  even  to  be  a  dean. 

Hughes:   Do  you  care  to  say  anything  about  some  of  the  individuals  in 

cardiovascular  surgery  at  UC?   I'm  thinking  of  people  like  Paul 
Ebert  and  Benson  Roe. 

Gerbode:   Paul  Ebert  has  been  very  recent.   He  caiie  from  New  York  just  a 

matter  of  a  few  years  ago  and  has  done  an  excellent  job.   He's  a 
very  nice  man,  and  I  like  him  as  a  friend  and  as  a  surgeon. 


230 


Gerbode:   I  think  Benson  Roe  was  the  chief  of  that  department  or  division 
before  [Ebert],  but  he  was  getting  close  to  retirement  age.   I 
suppose  that's  why  they  wished  to  have  a  younger  person  come  in. 

Hughes:   Have  you  considered  all  along  that  that  program  was  competitive 
with  yours? 

Gerbode:   It  was  terribly  competitive  when  Stanford  was  up  here,  when  we  were 
getting  started.   Without  bragging  at  all,  we  were  quite  a  bit 
ahead  of  their  department,  because  we  didn't  have  departmental 
jealousies  or  other  factors  to  interfere  with  us.  We  just  had  our 
own  show  and  good  people,  and  nobody  was  trying  to  interfere  with 
our  work.   It  makes  a  big  difference.  We  had  a  good  research 
program  going  as  well,  which  was  well  funded,  and  this  helped,  too, 
to  get  our  unit  established  sooner  than  theirs. 

Hughes:   I'm  hearing  the  theme  throughout  these  interviews  of  how  important 
it  is  to  tie  surgery  in  with  research,  and  I  was  just  wondering  if 
there  was  an  impact  when  the  Institute  of  Medical  Sciences  was 
founded. 

Gerbode:  I  think  when  we  got  the  Institute  of  Medical  Sciences  going,  and  a 
heart  research  institute  within  it,  and  it  had  very  ample  funding 
from  NIH,  this  made  a  big  difference,  because  we  could  then  train 
people  in  various  aspects  of  open  heart  surgery  and  postoperative 
care.  We  had  money  to  develop  machines  and  various  paraphernalia 
that  you  need  to  invent  or  buy  to  make  it  go  properly.  UC  didn't 
have  that. 

Hughes:   No,  it  didn't  but  when  Julius  Comroe  came  along  and  founded  the 
Cardiovascular  Research  Institute,  wasn't  one  of  the  motives  for 
founding  that  institution  to  provide  research  that  would  be  directly 
applied  to  heart  problems? 

Gerbode:   I  don't  know  what  the  people  had  in  mind  when  they  brought  Julius 
out  to  San  Francisco.   He  wasn't  particularly  involved  with 
cardiovascular  surgery  or  surgery  of  congenital  heart  disease  or 
even  acquired  heart  disease.  He  mainly  was  interested  in  pulmonary 
physiology,  and  he  was  the  leader  in  that  field.   Some  of  our 
people  went  over  and  took  courses  under  him  in  pulmonary  physiology. 
But  Julius  did  not  have  the  slightest  notion  of  how  to  train  a  man 
in  any  residency  sense.  He  was  not  interested  in  that  kind  of 
approach. 

Hughes:   He  had  a  more  strict  academic — ? 


231 


Gerbode:   He  had  a  very  strict  basic  research  goal  in  mind,  and  he  did  it 
very  well,  and  he  had  very  good  people  working  with  him. 

Hughes:    So  as  far  as  you  know,  that  wasn't  a  jumping  off  place  for — 

Gerbode:   I  don't  think  it  helped  the  heart  program,  as  far  as  I  can  see. 

Indirectly  I  think  some  of  the  people  who  went  over  there  and  took 
courses  under  him  helped  us  in  our  postoperative  care,  because  they 
had  some  very  good  basic  concepts,  which  Julius  was  teaching,  that 
helped  us  understand  pulmonary  problems  in.  postoperative  patients. 

Hughes:   Did  the  department  of  surgery  at  UC  have  a  strong  research  program? 

Gerbode:   I  don't  know  whether  you  could  say  it  was  very  strong  or  not.   They 
were  doing  research  and  had  been  for  quite  a  while.   But  they 
weren't  doing  the  kind  of  research  that  we  were  because  they  didn't 
have  a  big  enough  organization  and  funds  to  do  it  very  effectively. 

Hughes:   Do  you  think  some  of  that  could  be  attributed  to  the  policy  of  the 
regents? 

Gerbode:   No,  I  don't  think  so.   These  things  go  back  to  individuals  and  the 
chiefs  of  departments.   The  chiefs  of  the  departments  at  that  time 
were  men  who  weren't  very  talented  in  doing  research.   I  don't  want 
to  de-emphasize  them  or  anything,  but  they  were  more  or  less 
clinically  oriented.   Some  of  the  positions  they  took,  for  anyone 
wanting  to  push  open  heart  surgery  forward,  [must]  have  been  quite 
frustrating. 

Hughes:   UC  did  not  have  a  strong  tradition  of  medical  research,  certainly 

in  comparison  to  Stanford.   I  believe  it  was  well  after  World  War  II 
that  medical  research  was  emphasized,  and  some  of  that  was  because 
people  holding  positions  there  were  in  private  practice.   They  were 
taking  care  of  patients;  there  wasn't  a  place  in  their  lives  for 
the  research  lab.  Whereas  Stanford,  from  what  you've  said,  had 
always  honored  the  research  tradition. 

Gerbode:   Dr.  Holman,  my  chief,  was  very  strongly  oriented  toward  research, 
and  he  helped  young  people  do  work  in  the  laboratory.   He  was  not 
very  good  at  raising  money  for  them.   He  didn't  seem  to  think  that 
that  was  terribly  essential.   You  can  do  a  lot  with  a  little  bit 
of  money,  if  you  have  a  good  laboratory.   What  he  didn't  do  in  fund 
raising  for  the  lab,  he  did  in  actual  work  himself.  Even  in  the 
last  few  years  [of  his  life]  he  was  doing  some  research  in  the 
animal  laboratory. 


232 


Hughes:   Have  you  recognized  all  along  the  importance  of  the  fund  raising 
aspect  of  research? 

Gerbode:  You  can't  do  anything  in  medicine  without  money.   The  way  you 

get  money  is  by  publishing  good  papers  and  having  good  people  work 
with  you.   I  recognized  this  as  being  an  essential  aspect  from  the 
very  beginning.   Every  fellow  that  came  to  me  had  a  research 
problem,  and  they  knew  when  they  came  here  they  were  going  to  have 
to  do  research.   I  didn't  tell  them  what  kind  of  research  they  were 
supposed  to  do.   I  said,  "You  have  three  months  to  make  up  your  mind 
what  you  want  to  do,  but  I  want  you  to  have  a  research  program 
during  your  fellowship ,  and  I  want  you  to  do  something  that  you 
like  to  do." 

Hughes:   You  didn't  try  to  be  selective  about  what  that  research  was? 

Gerbode:   I  had  only  to  say  that  it  would  have  to  fit  in  with  what  the 

department  was  doing,  but  I  didn't  tell  anybody  they  had  to  do  one 
thing  or  another.   Some  of  them  did  research  on  certain  aspects  of 
the  use  of  heart-lung  machines.   Some  people  studied  anatomical 
[problems].   I  would  say  in  general  the  animal  laboratory  was  the 
basis  for  most  of  the  research  these  young  men  did. 

Hughes:   The  umbrella  was  something  to  do  with  the  cardiovascular  system? 

Gerbode:  The  umbrella  was  the  cardiovascular  system  or  lungs. 

Hughes:   Getting  back  to  the  appointment  at  UCSF,  what  did  you  actually  do? 

Gerbode:  That's  a  good  question.   Well,  I  didn't  do  very  much.   The  only  thing 
I  really  did  up  there  was  sit  on  a  couple  of  committees  which  were 
involved  with  decision-making  about  involvement  with  the  government 
in  various  programs.   I  was  on  a  couple  of  committees  which  met 
periodically  to  thrash  out  whether  to  join  these  programs  or  not, 
and  I  must  say,  it  was  a  lot  of  wasted  time.   I  went  there  because 
I  felt  that  the  old  Stanford  people  should  be  counted  in  the  decision- 
making.   But  actually  the  decisions  that  were  made  were  not  very 
effective,  and  it  didn't  really  matter  in  the  end. 

Hughes:   It  seems  unusual  to  have  a  person  such  as  yourself,  who  must  have 

been  looked  upon  as  a  competitor,  being  included  in  policy  decisions. 

Gerbode:  Yes,  I  suppose  some  people  didn't  like  that.   But  on  the  other  hand, 
I  think  they  recognized  that  I'm  pretty  fair-minded,  and  I  suppose 
they  would  assume  that  if  anybody  from  the  outside  were  going  to 
come  in  there  and  help  them  make  a  decision,  that  they  ought  to  get 
somebody  who  wasn't  too  prejudiced. 


233 


Hughes:    I  imagine  the  fact  that  you  had  been  such  a  successful  money-raiser 
for  your  own  institution  also  was  impressive,  was  it  not? 

Gerbode:   I  guess  that  counted  to  a  certain  extent, 
[interruption] 

Gerbode:   I  have  one  strong  feeling  about  UC,  which  I've  said  to  some  regents 
and  some  of  their  higher  staff  for  years.   I've  felt  all  along  that 
UC  is  physically  in  the  wrong  part  of  town.  The  reason  they're  up 
there  is  because  they  got  a  little  gift  of  land  and  the  Hooper 
Laboratory,  which  are  on  the  side  of  a  hill,  and  they  were  so  happy 
about  getting  it  for  nothing  that  they  built  everything  else 
around  it  at  great  cost.   It's  terribly  expensive  to  build  on  that 
ledge  up  there.   Furthermore,  I've  said  all  along  that  it's  the 
wrong  place  for  sick  people  to  have  to  go ,  because  there's  only  one 
bus  line.   It's  not  in  any  stream  of  traffic  anywhere.   It's  very 
difficult  for  people  to  get  there,  both  staff  and  patients.   I  had 
several  long  talks  with  [John  B.  de  C.M. ]  Saunders,  who  was  then 
chancellor,  about  this  subject.   In  fact,  he  came  and  talked  to  me 
about  it  at  one  point.   I  said  I  thought  they  ought  not  to  abandon 
that  whole  center  up  there,  but  de-emphasize  it  and  build  a  whole 
new  center  [in]  Japantown.   It  was  relatively  cheap,  because  it  was 
low-cost  housing.   There  is  ready  access  from  various  directions, 
and  good  transportation  facilities. 


Gerbode:   [Saunders]  felt  that  the  students  at  UC  were  not  getting  as  good 

bedside  teaching  as  they  should  be  getting.   I  don't  know  why  he  felt 
that.  He  actually  thought  of  starting  a  whole  new  campus  somewhere 
else,  which  I  felt,  too,  would  be  a  good  long  term  move.   There 
were  many  parts  of  the  Parnassus  site  which  could  be  used  for  other 
medical  aspects. 

Hughes:   He  didn't  have  a  location  in  mind? 

Gerbode:   He  thought  this  Japan  Center  idea  was  a  good  one.   But  of  course  the 
politics  involved  with  anything  like  that  are  really  terrific. 

Hughes:   What  would  be  the  argument  for  staying  at  Parnassus? 

Gerbode:   Because  they'd  already  put  millions  into  the  place.   It's  just  like 

pourirg  good  money  after  bad.   The  money  comes  from  the  state  treasury 
so  it's  easier  to  get.   If  they  had  to  survive  on  that  edge  up  there 
on  the  basis  of  private  support,  they'd  never  make  it.   I  think  it's 
a  very  bad  place  geographically  for  a  big  medical  center.   They  have 
to  build  vertically,  and  the  parking's  terrible. 


234 


Hughes:   Did  anybody  listen  to  you? 

Gerbode:  They  listened  to  me,  but  then  they  didn't  do  anything  about  it. 

Hughes:   Did  you  speak  to  the  regents  informally?  You  didn't  actually  appear 
before  the  board,  did  you? 

Gerbode:   No,  just  informally. 
Hughes:   You  happened  to  know — ? 

Gerbode:  I  knew  one  regent  who  was  very  important,  and  I  talked  to  him  quite 
a  bit  at  some  length  about  this.  He  used  to  show  me  the  budgets  of 
the  UC  Medical  School  and  ask  me  to  comment  on  the  budget  requests, 
which  I  thought  was  probably  not  very  [proper]  to  do.  But  I  didn't 
have  much  to  suggest  about  their  budgets. 

Hughes:   Those  seemed  to  be  in  line? 

Gerbode:  They  were  all  right.  The  hospital  and  the  medical  school  should  be 
down  where  people  could  get  to  it,  as  they  have  it  in  Houston.   They 
decided  in  Houston,  wisely,  that  they  would  put  all  their  big 
institutions  on  a  campus.   So  their  hospitals  are  fairly  close  to 
each  other,  and  the  medical  school  is  close  to  the  hospitals.   Every 
thing  is  flat  so  you  can  drive  there  easily  and  buses  can  get 
there  easily.   None  of  these  things  can  happen  up  on  Parnassus. 

Hughes:   There  has  been  a  longstanding  controversy  about  whether  the  campus 
should  be  at  Berkeley. 

Gerbode:   I  know  about  that. 

Hughes:   Did  you  ever  have  any  input  into  that? 

Gerbode:  Oh,  I  heard  discussions  about  it.   But  the  clinical  men  in 
San  Francisco  were  too  powerful  to  let  that  happen. 

Hughes:   They  didn't  want  to  give  up  their  practices? 

Gerbode:  They  just  didn't  want  to  move  to  Berkeley.   They  didn't  want  to  be 
close  to  the  campus  and  the  campus  activities.   You  see,  as  soon  as 
you  move  over  there,  then  you  have  the  professors  of  anatomy  and 
biochemistry  and  all  the  other  basic  sciences  looking  down  your 
throat,  and  they  didn't  like  that  idea.   They  wanted  to  be 
independent  of  that.   So  what  finally  happened  is  that  they  moved 
the  various  basic  science  departments  to  San  Francisco.   They  did 
just  the  reverse. 


235 


Hughes: 
Gerbode: 

Hughes: 
Gerbode: 


Hughes: 


Gerbode: 


Hughes: 
Gerbode: 


Hughes: 


Gerbode; 


Yes,  and  that  caused  a  lot  of  trauma,  too. 

And  that  caused  a  lot  of  trauma,  too.  But  actually  the  clinical 
men  who  were  very  powerful  at  that  time  were  the  ones  who  really 
swayed  that. 

The  rationale  was  that  they  didn't  want  to  be  too  close  to  the 
basic  scientists? 

They  didn't  want  to  be  under  close  scrutiny.   That's  why  some  of  the 
people  didn't  move  to  Palo  Alto,  too,  when  Stanford  moved.   This 
proved  to  be  true,  because  there  are  people  that  went  to  Stanford, 
who  still  are  very  unhappy  about  the  whole  move  and  what  happened. 

Yet  from  a  purely  academic  standpoint,  I  should  think  that  a  close 
association  between  basic  research  people  and  applied  scientists, 
if  you  want  to  call  them  that,  could  be  very  fruitful. 

It's  always  held  to  be  very  advisable.   At  Columbia  in  New  York  they 
put  the  physiologists  and  the  biochemists  right  across  the  aisle  from 
the  chiefs  of  departments,  thinking  there  would  be  cross-fertilization 
and  free  communication.   They  wouldn't  even  open  the  door  to  go 
across  from  one  side  of  the  building  to  the  other. 

Why  are  people  like  that? 

I  don't  know.   I  don't  know  even  at  Stanford  now  whether  the 
clinical  departments  really  spend  much  time  with  the  physiologists 
or  the  biochemists.   I  think  they  have  their  own  programs,  which 


are  quite  separate  from  the  clinical  programs, 
fertilize  each  other  hardly  at  all. 


I  don't  think  they 


You  mentioned  when  we  were  talking  about  the  institute,  that  there 
was  some  problems  of  the  same  nature  here,  in  that  the  hospital 
people  are  not  very  good  about  attending  lectures  and  seminars  given 
by  the  research  people  of  the  institute.   So  that  seems  to  be  a 
common  characteristic. 

It's  a  common  characteristic.   See,  the  people  who  finally  emerge 
as  the  leaders  in  medical  departments  frequently  are  not  research 
minded.   In  places  where  there  are  research  departments,  their 
institutions  and  their  departments  have  gained  tremendous  stature. 
I'll  give  you  one  example.   Duke  University,  where  the  professor  of 
surgery  is  David  Sabiston,  has  always  had  a  very  fine  research 
program,  in  which  his  fellows  and  residents  participate  and  publish 
papers.   It's  an  outstanding  department,  and  he's  a  very  good  clinical 
surgeon  as  well,  so  he  didn't  sacrifice  anything  by  spending  a  lot  of 


236 


Gerbode:   time  [on  research].   In  fact,  his  clinical  program  benefited 

enormously  because  of  the  research.  But  on  our  campus,  the  men 
in  charge  of  clinical  programs  are  completely  without  any  back 
ground  in  research. 

Hughes:   Do  you  think  that  goes  back  to  a  fault  in  their  medical  education? 

Gerbode:  Well,  I  suppose  you  have  to  have  the  research  bug  in  your  craw 

somewhere  along  the  line,  and  those  who  have  too  much  of  a  research 
bug  in  their  craw,  sometimes  are  not  considered  as  good  clinically. 
So  the  rare  combination  of  somebody  who  can  do  the  research  and 
has  the  desire  to  do  it,  and  at  the  same  time  is  a  good  clinician 
[is]  the  best,  I  think. 


The  California  State  Board  of  Health 


Hughes:   Another  topic  is  the  California  State  Board  of  Health. 

Gerbode:   I  suppose  I  got  that  [appointment]  because  of  the  Crippled  Children's 
Program.   We  were  the  first  in  northern  California  to  be  approved 
by  the  Crippled  Children's  Program  to  do  heart  surgery  in  children. 
I  can't  quite  remember,  but  I  think  they  gave  me  an  appointment  on 
the  State  Board  of  Health  to  cover  that  aspect  of  it. 

Hughes:   Does  that  mean  that  you  had  to  have  some  state  affiliation  in  order 
to  receive  funds  from  Crippled  Children's? 

Gerbode:  No.   I  think  [it  was]  because  the  state  was  paying  for  the  work,  and 
they  had  to  approve  my  unit  to  do  the  work. 

Hughes:   So  that  was  just  a  paper  appointment? 
Gerbode :  Yes . 


Visiting  Professorships 


Hughes:   The  rather  large  topic  of  your  visiting  professorships. 

Gerbode:   I  found  that  very  interesting,  and  I  could  talk  about  each  one 
individually  if  you  like. 

Hughes:   Why  don't  you  do  that. 


Gerbode: 


237 


St.  Bartholomew's  Hospital,  London,  1949 


My  first  real  [foreign]  exposure  after  the  war  was  1949,  when  1 
went  to  St.  Bartholomew's  Hospital. 


Hughes:   We  have  talked  about  that  one  in  an  earlier  interview. 


The  Royal  North  Shore  Hospital,  Melbourne,  1953 


Gerbode:   Some  of  the  other  visiting  professorships  were  in  Australia. 
Hughes:   One  was  in  1953  at  the  Royal  North  Shore  Hospital. 

Gerbode:   Yes,  that  came  about  because  of  Frank  Rundle,  who  was  then  chief 
of  surgery  there,  and  he  had  worked  with  me  in  our  experimental 
laboratory.   He  wanted  to  get  research  going  in  Australia  on  a 
full-time  basis  in  these  various  institutions,  so  he  invited  me  to 
come  down  there  as  a  visiting  professor.   I  gave  lectures  in 
Melbourne  and  some  other  places,  and  even  one  TV  appearance 
suggesting  that  they  ought  to  have  full-time  [academic]  people 
there.   In  most  of  the  medical  schools  in  Australia  at  that  time, 
the  clinical  positions  were  [held  by]  practicing  physicians  [who 
were]  not  very  keen  on  research,  in  fact  not  very  keen  on  modern 
teaching  methods.   But  this  has  been  vastly  improved  since  then. 

Hughes:   Was  that  the  influence  of  the  British  system? 

Gerbode:   I  think  quite  a  bit.   They  were  copying  the  British  consultant 

methods.   But  in  any  event,  I  went  to  the  North  Shore  Hospital  and 
gave  lectures  and  made  suggestions  about  their  research  program, 
helped  Frank  Rundle  get  a  full-time  clinical  research  unit  started. 
He  got  it  funded  locally  himself.   He  got  some  young  people  going, 
and  they  are  now  professors  and  running  that  clinical  research  unit. 
I  had  to  do  a  certain  number  of  operations.   That  was  before  open 
heart  surgery  had  gotten  started,  so  I  did  some  closed  heart 
surgery.   Some  of  the  patients  I  operated  upon  still  correspond  with 
me. 

Hughes:   Had  Frank  Rundle,  because  he  had  been  in  your  lab,  already  introduced 
the  techniques  that  you  were  using? 

Gerbode:  He  was  not  a  cardiac  surgeon.  He  was  mainly  an  idea  man  who  put 
together  concepts,  and  he  finally  became  dean  of  the  new  medical 
school  and  put  together  a  whole  new  medical  school  in  Sydney.  He 


238 


Hughes:   was  not  very  well  liked  by  people,  because  he  was  rather  blunt. 
But  he  got  the  job  done.   He  was  mainly  a  thyroid  surgeon.   That 
was  his  best  operation. 

Hughes:   So  you  had  a  lot  of  work  to  do  to  introduce  the  new  surgical 
techniques  that  you  were  then  very  much  developing. 

Gerbode:   There  were  a  certain  lumber  of  closed  heart  techniques  which  we 
had  been  doing  in  San  Francisco.   It  was  relatively  easy  to 
demonstrate  those.   The  people  that  were  assisting  me  were  good 
surgeons  and  nice  people. 

Hughes:   And  receptive? 

Gerbode:  They  were  very  receptive.  The  chairman  of  the  board  of  trustees 

was  very  kind  to  me  and  introduced  me  to  people  and  listened  to  me. 
I  think  I  may  have  made  a  contribution  there. 

Hughes:  When  you  did  something  like  this,  was  it  a  setback  as  far  as  your 
own  research  interests  were  concerned? 

Gerbode:   No,  [the  research]  would  keep  on  going,  because  there  were  young 
people  [in  San  Francisco]  working  on  the  program.   I  was  not  gone 
for  very  long. 

Hughes:   You  didn't  stay  a  whole  year? 

Gerbode:  No.  I  stayed  almost  a  year  in  London.  But  that  was  before  I  had 
a  big  research  program  going  involving  a  lot  of  different  things. 
I  didn't  get  that  started  until  eight  or  nine  years  later. 


The  Prince  Henry  Hospital,  Sydney,  1963 


Gerbode:   I  went  back  to  Australia  [in  1963  to  the  Prince  Henry  Hospital]. 
At  that  time  we  had  started  our  open  heart  surgery  program,  so  I 
was  invited  down  really  to  help  them  in  open  heart  surgery.   I  took 
my  chief  nurse  with  me,  Marilyn  Blake,  who  is  still  the  chief  heart 
surgery  nurse  in  the  hospital.  I  had  trained  her  first  in  our 
experimental  laboratory.   She  and  Nancy  Nagareda  came  when  we  did 
our  first  dog  surgery  many  years  ago.  They're  both  still  there  in 
the  operating  room.   They're  great.  When  operating  with  those  girls, 
I  didn't  even  need  to  ask  for  an  instrument.   It  was  always  in  my 
hand.   They  could  look  over  and  know  what  I  was  going  to  do  next. 


239 


Hughes :   Did  you  take  your  family? 

Gerbode:   I  took  my  wife.   They  put  us  up  at  a  very  nice  little  cottage  on 

the  campus.   The  other  interesting  thing  about  it,  they  assigned  a 
pastry  cook  to  cook  pastries  and  bread,  so  everyday  these  huge 
quantities  of  cookies  and  cakes  and  bread  would  arrive,  none  of 
which  I  eat  very  much.   We  were  constantly  giving  all  this  stuff 
away  to  various  people  in  the  hospital. 

Hughes:   The  cook  was  assigned  just  to  you? 

Gerbode:   Yes.   It  actually  was  very  interesting  to  be  at  the  Prince  Henry 
Hospital.   At  one  point  during  that  experience,  they  invited  all 
the  heart  surgeons  from  New  Zealand  and  Australia  to  come  to  the 
hospital  for  a  session  on  the  status  of  heart  surgery.   At  one 
point  I  was  doing  a  blue  baby  operation,  tetralogy  of  Fallot,  before 
all  this  illustrious  group.   After  I'd  finished  the  repair  on  this 
little  girl,  there  was  one  last  thing  I  had  to  do,  and  that  was  to 
tie  off  a  previous  Blalock  at  the  left  subclavian  artery,  an 
anastomosis  which  had  been  done  previously  at  a  blue  baby  operation. 
As  I  tied  this  artery,  the  tie  cut  it  off  completely  from  the  aorta, 
which  caused  an  enormous  flooding  of  blood  all  over  the  place,  at 
which  point  the  very  kindly  and  sympathetic  surgeons  walked  out, 
thinking  that  this  was  the  end.   But  I  put  my  finger  over  this  place 
where  the  artery  had  been  torn  loose,  and  asked  the  engineer  who  had 
invented  the  heart-lung  machine  we  were  using,  a  man  by  the  name 
of  [Vivian  R. ]  Ebsary,  who  had  become  a  millionaire  after  the  war 
through  his  engineering  work,  if  he  could  reduce  the  body  temperature 
in  this  little  girl.   He  said,  "Yes,  I  can  do  that."  So  I  said, 
"All  right,  you  lower  the  body  temperature  down  to  about  twenty 
degrees,  and  then  I'll  see  if  I  can  repair  this  thing."  So  he  did, 
and  in  about  twenty  minutes  or  so  he  had  the  body  temperature  down 
to  twenty  degrees. 

Hughes:   Your  finger  was  still  over  the  hole? 
Gerbode:   Still  over  the  hole. 

We  turned  off  the  machine  entirely,  and  then  there  was  just  a 
little  dribble  of  blood  coming  out  of  the  hole,  because  there 
wasn't  any  pressure  in  it,  and  I  was  able  to  see  it  and  sew  it.   I 
got  the  other  end  and  tied  that.   Then  we  warmed  her  up  again  and 
started  the  machine,  and  in  another  twenty  minutes  or  a  half  hour, 
the  temperature  was  normal,  and  everything  was  dry.   So  then  all  the 
visiting  firemen  came  back  into  the  operating  room.   They  were  rather 
amazed  that  we  had  gotten  out  of  this  terrible  situation. 


240 


Gerbode:  Anyway,  that  little  girl  became  a  very  accomplished  pianist.   She 
knitted  me  a  sweater  sometime  after  the  operation  and  sent  it  to 
me.   I  used  to  hear  from  her.   I  think  she's  probably  married  and 
has  a  dozen  children  at  this  point.  She's  a  very  sweet  girl,  with 
a  lovely  mother. 


St.  Thomas'  Hospital,  London,  1958 


Hughes:   Then  you  went  back  to  London  in  1958  to  St.  Thomas'  [Hospital]. 

Gerbode:  Yes.  John  Kinmouth,  who  was  a  professor  of  surgery  there,  asked  me 
to  be  a  visiting  professor.   So  I  went  back,  and  I  did  a  few  simple 
operations  there  and  helped  them  try  to  get  their  open  heart  program 
going.   They  were  still  in  the  laboratory  working  with  the  machines, 
not  on  humans.   I  helped  them  a  little  in  getting  their  machinery 
together  and  getting  organized.   But  they  didn't  have  anybody  who 
could  really  take  it  on.   John  Kinmouth  thought  that  he  might  like 
to  do  it,  but  then  he  really  didn't  have  the  time,  being  chairman  of 
the  department,  to  really  work  at  it  very  seriously. 

Hughes:   You  mean  the  whole  field  of  open  heart  surgery? 

Gerbode:  Yes.   So  he  confined  his  activities  to  peripheral  vascular  surgery, 
and  it  wasn't  until  later  that  one  of  our  trainees,  Mark  Bainbridge, 
was  invited  to  go  there.   He  then  took  hold  of  the  program,  and  now 
has  one  of  the  finest  open  heart  programs  in  all  of  England.  Mark 
has  trained  people.  He's  done  excellent  research.  He's  very  highly 
thought  of  by  the  profession  at  large.   And  I'm  godfather  to  one  of 
his  sons. 

Hughes:   What  sort  of  heart-lung  machine  was  being  used  in  1958? 

Gerbode:  At  that  time  they  were  using  one  which  we  had  invented,  the  so-called 
Bramson  disk  oxygenator.   But  later  on  everybody  pretty  much 
switched  to  bubble  oxygenators,  because  they  were  cheaper  and 
easier  to  put  together  and  run. 

Hughes:   If  I  remember  correctly,  there  was  a  chap  at  the  Hammersmith  Hospital, 
whose  name  I've  forgotten,  working  on  a  heart-lung  machine? 

Gerbode:  Yes,  Dennis  Melrose.   He  invented  a  machine  which  was  like  a 

washing  machine  in  a  sense.   It  had  big  baffles  which  thrashed  blood 
around,  and  it  was  rather  traumatic  to  blood. 


241 


Hughes:   Melrose's  machine  was  not  being  used  at  the  Hammersmith? 

Gerbode:   No.   He  introduced  it  to  the  continent,  and  it  was  used  in  East 

Europe  by  some  units  for  a  while.   But  when  the  bubble  oxygenators 
came  into  being,  they  quickly  switched  to  those. 

Hughes:   How  did  it  come  to  be  that  St.  Thomas'  unit  picked  up  on  your 
machine  rather  than  Melrose's? 

Gerbode:   Because  we'd  already  demonstrated  that  ours  was  better. 


The  Free  University  of  West  Berlin,  1960 


Hughes:   In  1960  you  were  guest  professor  at  the  Free  Thiversity  of  West 
Berlin. 

Gerbode:   Yes.   Professor  [Fritz]  Linder  was  the  chairman  of  the  department. 
That  was  a  very  interesting  experience.   They  took  good  care  of  me. 
They  gave  Mrs.  Gerbode  and  me  a  nice  apartment  in  town  and 
transportation  to  get  around.   I  took  Miss  Blake  over  with  me 
again  to  help  with  the  operations.   We  made  a  lot  of  suggestions 
about  how  to  inprove  their  sterile  techniques. 

Hughes:   Were  theirs  not;  very  good? 

Gerbode:   They  were  in  an  old  hospital,  and  it  was  difficult  in  many  ways.   But 
I  think  they  accepted  some  of  the  things  we  suggested.   I  operated 
quite  a  bit  there.   They  gave  me  the  worst  possible  cases  to  do. 

Hughes:   Can  you  say  something  about  the  state  of  heart  surgery  in  West 
Germany? 

Gerbode:   They  were  just  starting  it.   They  had  a  fellow  running  the  machine 
who,  as  soon  as  I  saw  him  operating,  I  knew  was  not  going  to  be 
any  good  at  all.   He  was  an  American,  who  kind  of  grew  up  in  that 
department  in  West  Berlin.   But  he  was  a  very  opinionated  person  and 
not  very  smart.   I  very  quickly  told  the  professor  that  he  shouldn't 
be  in  charge  of  that  part  of  the  work.   He  was  really  quite 
dangerous.   So  he  was,  I  think,  sent  back  to  America.   I  don't  know 
what  happened  to  him,  but  I  hope  he  didn't  try  to  run  a  heart-lung 
machine  when  he  came  back. 


242 


Gerbode:   I  gave  a  number  of  lectures  there  in  English.  At  that  time  most 

of  the  Germans  were  not  very  good  at  English.  Now,  of  course,  they 
all  speak  good  English,  because  English  is  the  second  language  in 
most  European  schools.   So  they  had  to  translate  some  of  my 
little  talks.  They  had  simultaneous  translation.   But  it  was  a 
very  interesting  experience  to  be  there  and  to  go  into  East  Berlin, 
as  we  did  a  few  times,  to  the  opera  and  concerts  and  to  see  how 
the  Russians  in  the  Unter  den  Linden,  which  is  their  famous 
street,  had  built  up  the  front  of  the  buildings  to  look  very 
impressive.   But  if  you  took  the  road  in  back  of  the  buildings,  they 
were  pretty  cheesy  looking. 


The  University  of  Heidelberg,  1964 


Hughes:   Then  another  trip  to  Germany  in  1964,  to  the  University  of  Heidelberg. 

Gerbode:  Yes.   Professor  Linder  went  to  Heidelberg.   It  was  a  big  decision 

on  his  part.   I  perhaps  helped  him  make  that  decision  as  to  whether 
he  should  stay  in  West  Berlin — they  were  promising  him  a  new 
hospital — or  whether  he  should  go  to  Heidelberg.   I  think  Mrs. 
Linder  wanted  to  stay  in  West  Berlin.   She  rather  liked  it.   But  the 
challenge  of  being  in  Heidelberg,  which  of  course  is  a  famous  old 
university,  was  a  greater  one,  I  felt,  and  I  urged  him  to  take  it. 
I  think  he  went  there  believing  he  could  change  the  concept  of  the 
German  professor,  in  the  sense  that  the  German  professor  was  the 
only  one  who  really  had  private  patients.  He  could  allocate  some 
patients  to  somebody  else  in  the  department.   The  old  German  professor 
didn't  allow  anybody  to  rise  up  and  be  great  under  him.   I  think 
when  Fritz  went  there  he  wanted  to  change  that,  and  I  think  he  did 
succeed.  He  retired  from  that  chair  just  recently.   I  think  he 
succeeded  in  having  his  assistants  in  various  departments  become 
prominent  on  their  own  without  too  much  governance. 

Hughes:   What  were  his  feelings  about  the  importance  of  research? 

Gerbode:  He  thought  research  was  very  important.   He  started  some  research 

there  and  got  some  of  his  young  people  to  do  research,  but  never  on 
a  very  vast  scale.  Most  of  the  contributions  from  that  department 
were  clinical  contributions. 

Hughes:   Was  that  true  of  German  surgery  as  a  whole,  that  it  was  not  closely 
allied  with  research? 


243 


Gerbode:   It  was  a  slow  transition  after  the  war,  because  the  Germans  really 
were  the  first  country  in  Europe  after  the  war  to  realize  that 
research  was  terribly  important.   So  they  allocated  a  fair  amount 
of  money  for  research  to  various  university  centers,  and  helped 
young  people  get  started.   And  this  still  is  true.   I  think  anyone 
who  has  a  good  research  concept  in  Germany  can  get  funded,  and  also 
contributions  in  research  are  rewarded  in  the  academic  ladder,  which 
is  very  important.   They're  following  the  Americans  in  this  respect, 
because,  as  we  mentioned  before,  one  of  the  big  rewards  for  research 
is  to  promote  the  person  academically,  give  him  a  better  position  in 
the  structure. 


The  Karolinska  Hospital,  Stockholm,  1964 


Hughes:   In  1964,  the  same  year,  you  were  a  lecturer  and  surgeon  at  the 
Karolinska  Hospital  in  Stockholm. 

Gerbode:   Yes.   They  asked  me  to  go  there  to  be  surgeon  in  residence  in 

the  most  famous  cardiac  hospital  in  Sweden.   I  went  there  at  the 
request  of  Professor  Crafoord,  who  was  one  of  the  pioneers  in 
cardiac  surgery.   I  think  he  brought  me  there  because  he  wanted  to 
get  my  ideas  about  the  treatment  of  tetralogy  of  Fallot.   So  I  did 
some  cases  for  him  there. 

H 

Gerbode:  My  good  friend  Viking  Olov  Bjork  was  the  assistant  and  was  more  or 
less  in  line  to  succeed  Clarence  Crafoord.  He  had  to  go  back  to 
become  professor  at  Uppsala  University  first,  which  he  did  very 
successfully,  and  he  always  did  great  research.  He  always  is  doing 
some  research  and  publishing. 

Hughes:   Crafoord,  of  course,  had  a  long  research  tradition. 

Gerbode:   He  had  a  long  research  background.   He  was  one  of  the  first  to  start 
experiments  with  an  artificial  heart-lung  machine.   They  made  a 
disk  oxygenator,  one  of  the  very  first,  experimentally,  and  used 
it  clinically  some  years  after  everybody  else  had  gotten  into  the 
field.   Even  in  1949,  when  I  went  over  there,  they  had  a  disk 
oxygenator  they  were  experimenting  with  in  dogs.   They  showed  it  to 
me  in  their  lab.   There  were  several  other  groups  in  Europe  at  the 
same  time  who  were  doing  research  on  disk  oxygenators.   But 
anyway,  the  group  in  Stockholm  was  very  kind  to  me  and  very 
hospitable.   I  gave  a  few  talks,  they  put  me  up  in  a  very  nice 
accommodation,  and  gave  me  a  very  nice  stipend  to  be  there. 


244 


Gerbode:   Going  back  to  the  Free  University  of  West  Berlin,  when  I  went  over 
there,  I  took  a  first-class  ticket  for  me  and  my  wife.   They  said, 
"We'll  pay  your  transportation."  So  I  submitted  my  bills  for 
transportation  to  the  bourse  at  the  university,  who  is  the 
treasurer  of  the  university,  and  after  I  had  been  there  a  while, 
she  said  she  wanted  to  talk  to  me  about  my  expenses.   So  I  went 
over  to  her  office.   She  said,  "I  don't  understand;  we  invited  a 
professor  of  pediatrics  over  from  Los  Angeles  around  the  same  time, 
and  his  travel  expenses  are  quite  a  bit  less  than  yours."  I  said, 
"How  did  he  travel?"  She  said,  "I  guess  he  traveled  economy." 
I  said,  "The  thing  you  have  to  remember  is  that  surgeons  always 
travel  first-class."   [laughter]   She  was  so  amused  at  that,  she 
said,  "Oh,  that's  fine." 

Hughes:   I'd  like  to  hear  a  little  bit  about  Crafoord  as  an  individual. 

Gerbode:   Clarence  Crafoord  did  the  first  coarctation  in  Europe  and  one  of 
the  first  in  the  world  at  the  same  time  that  Bob  Gross  did  one  in 
Boston.   He  did  other  operations  in  the  cardiovascular  field,  too, 
not  open  heart  operations  originally,  but  he  did  patent  ductus 
procedures  very  early  on,  and  did  some  closed  mitral  operations,  too. 
But  he  was  considered  one  of  the  great  European  pioneers,  a  world 
pioneer  in  cardiac  surgery.   He  attended  all  the  big  meetings, 
always  had  something  constructive  and  useful  to  say.   I  think  he 
would  probably  consider  me  a  friend. 

Hughes:   Did  you  ever  operate  with  him? 

Gerbode:  Yes,  when  I  went  there  as  visiting  surgeon  at  the  Karolinska.  He 
either  scrubbed  with  me  or  was  there  in  the  operating  room  when  I 
was  operating. 

Hughes:   Do  you  have  any  comments  to  make  on  his  surgical  technique? 

Gerbode:  He  was  very  meticulous  as  a  surgeon.   Extremely  careful  about 
detail.  He  had  an  operating  nurse  who  worked  with  him  called 
Sister  Lisbet — that  is  Elizabeth — and  she  actually  is  still  there 
in  some  capacity  working  with  Viking  Bjork.   She  came  here  a  number 
of  years  ago  on  a  leave  of  absence  and  passed  her  nurses'  examination 
in  the  States,  so  she  could  come  back  here  sometime  if  she  wanted 
to  and  practice  nursing.   But  she  has  never  come  back. 

Hughes:   What  was  Crafoord  like  as  an  individual? 

Gerbode:  Well,  typical  Swedish  personality.  A  little  brusque  and  rather 
opinionated  about  some  things.   He  was  well  liked  by  people. 


245 


Hughes:   Did  he  allow  the  young  people  in  his  department  to  have  room  to 
move  ahead  ? 

Gerbode:   He  brought  two  great  surgeons  forward.   One  of  them  was  Ake  Senning, 
who  went  to  Zurich  as  the  professor  of  surgery  and  has  done  an 
outstanding  job  there.   And  the  other  one  was  Viking  Bjork.   There 
were  other  [members  of  his  team]  who  got  lesser  jobs  in  Sweden. 
He  was  one  who  sponsored  young  people,  no  question  about  it. 

Hughes:   He  was  responsible  for  putting  cardiovascular  surgery  on  the  map 
in  Sweden,  was  he  not? 

Gerbode:   Oh  yes,  he  certainly  was. 

Hughes:   Was  he  a  revered  name  all  over  Europe? 

Gerbode:   Yes,  and  in  the  world.   He  was  always  invited  to  speak  or  comment 
wherever  he  went  to  medical  meetings.   He's  still  living.   You 
don't  need  to  put  this  down  anywhere,  but  he  called  me  long  distance 
about  eight  months  ago  and  wanted  me  to  quickly  send  my  curriculum 
vitae  to  him.   I  don't  know  why.   He  wanted  it  by  return  mail  for 
some  reason.   He  wanted  to  propose  me  for  something,  I  guess, 
which  didn't  materialize.   [laughter] 

Hughes:   Another  deanship! 

Gerbode:   No,  I  think  he  wanted  to  suggest  that  I  be  made  a  member  of  some 

organization,  but  apparently  it  didn't  go  through,  because  I  haven't 
heard  anything  from  him  since. 


Duke  University,  Durham,  North  Carolina,  1973 


Hughes:   We  skip  nine  years,  and  then  in  1973  you  were  guest  professor  of 
surgery  at  Duke.   Was  there  a  reason  for  the  long  interval? 

Gerbode:   I  was  busy  keeping  the  unit  going  and  training  young  people.   They 
were  building  a  new  hospital  [at  PMC]  during  that  time,  too.   There 
was  a  lot  of  work  with  the  architects  and  planning  that  needed 
doing.   We  were  working  a  lot  on  postoperative  care  and  the 
monitoring  of  patients  during  that  time,  because  we  had  the  first 
real  computerized  monitoring  unit  in  the  world.   It  took  a  lot  of 
work  to  get  that  mounted  properly.   Jack  Osborn  and  IBM's  Jim  Beaumont 
were  in  charge  of  that  and  did  a  fantastically  good  job.   We  also 


246 


Gerbode:  had  another  fellow  by  the  name  of  Bob  Eberhart ,  who  was  a  Ph.D. 
who  worked  very  hard  in  that  field  and  helped  our  program  a  good 
deal.   He  is  a  biomedical  engineer  and  is  now  a  professor  in 
Texas. 

Hughes:   Was  the  computer  program  off  the  ground  when  you  were  at  the 
Karolinska? 

Gerbode:   No. 

Hughes:   What  was  the  reason  for  the  invitation  from  Duke? 

Gerbode:   I  guess  Dave  Sabiston  had  always  had  people  he  thought  of  value 

come  there,  because  he  had  a  very  fine  training  program,  and  I  guess 
he  liked  to  have  his  young  men  [talk  to]  people  who  had  done  something 
that  he  considered  valuable  in  the  country.   So  I  spent  a  lot  of 
time  with  his  residents,  just  talking  about  philosophy  of  surgery 
and  why  things  were  done  and  who  did  them,  and  what  was  important. 
I  don't  think  I  operated  when  I  was  there.   I  think  I  just  talked 
and  collaborated  on  some  of  the  operations  they  were  doing. 


The  University  of  Alberta  at  Edmonton,  1974 


Hughes:   The  University  of  Alberta  at  Edmonton. 

Gerbode:   John  Callaghan  was  one  of  the  first  fellows  I  had  in  training, 

before  we  really  got  our  open  heart  surgery  program  going.   We'd 
done  a  lot  of  experimental  work  together  before  we  had  heart- 
lung  machines.   We  did  some  things  which  now  sound  rather  childish, 
but  we  worked  very  hard  in  the  laboratory  and  did  some  cases  in  the 
early  '50s. 

Hughes:   Which  kind? 

Gerbode:   Open  heart  cases.  Which  were  not  very  successful,  I  might  say. 

He  went  up  to  Edmonton,  became  chief  of  cardiac  surgery,  and  finally 
developed  a  very  fine  program.  He's  now  retired,  too.   Then  in 
1974  I  went  to  Edmonton  as  his  visiting  professor.   I  didn't 
operate.   I  just  lectured  and  observed  his  cases  and  talked  to  the 
residents.   It  was  a  very  nice  experience.   They  have  a  very  fine 
medical  school  there. 

Hughes:   Are  the  Canadians  more  akin  to  the  American  system  of  training  than 
to  the  British? 


247 


Gerbode:   Oh  yes,  absolutely. 

Hughes:   We  talked  about  your  contributions  to  these  various  institutions 
when  you  were  a  guest;  do  you  think  you  came  away  with  anything 
from  these  experiences? 

Gerbode:   You  always  gain  something  in  one  of  these  assignments.   Attitudes, 
objectives  make  an  impression  on  you.   I  don't  think  I  learned  too 
much  from  them  about  the  technical  aspects.   But  I  learned  some 
things  not  to  do. 

Hughes:  From  seeing  it  demonstrated? 

Gerbode:  Yes.   In  some  institutions. 

Hughes:  Do  you  have  anything  more  to  say  about  your  guest  professorships? 

Gerbode:  No,  I  think  we've  covered  that  subject  pretty  well. 


248 


VII  COMMENTS  ON  MEDICAL /SURGICAL  TOPICS 
[Interview  10:   September  27,  1983 ]## 


More  on  Research  in  the  Surgical  Laboratory  of  the  Old  Stanford 
Medical  School 


Gerbode:   One  of  the  great  assets  of  the  old  Stanford  Medical  School  on  Clay 
and  Webster  Streets  was  the  surgical  lab,  which  had  been  developed 
by  Dr.  Holman  and  Dr.  Reichert.  We  usually  had  fifteen  or  twenty 
animals  for  experimental  surgery  and  research.   I  was  granted 
the  privilege  of  having  a  small  room  in  the  laboratory  during  my 
assistant  residency,  and  later  I  spent  virtually  a  whole  year  doing 
surgical  research  in  the  old  laboratory.   It  was  a  dirty  place, 
filled  with  cockroaches  and  ticks  and  whatnot.   It  was  virtually 
impossible  to  eliminate  this  hoard  of  invaders  because  of  the  age 
of  the  building.   They  had  gone  under  the  rugs  and  in  the  walls 
and,  although  they  had  exterminators  there  on  a  regular  basis,  all 
they  could  do  was  keep  down  the  population  to  a  certain  extent. 

However,  the  spirit  in  the  laboratory  was  great,  and  a  great 
many  of  my  fellows,  and  of  course  Dr.  Holman  and  Dr.  Reichert,  were 
constantly  doing  research  on  animals.   We  were  never  really 
bothered  by  the  antivivisectionists,  although  a  couple  of  times 
they  tried  to  send  spies  up  to  see  if  they  could  find  something  to 
complain  about.   But  they  were  spotted  and  ushered  out  of  the 
place  quite  quickly. 

In  any  event,  the  first  experimental  work  I  did  was  with  Dr. 
Reichert  in  studying  a  rare  inflammatory  disease  of  the  bowel.   This 
work  was  published  sometime  later.   Dr.  Reichert  taught  me  the 
necessity  for  accuracy  and  the  value  of  good  observations.  After 
the  war,  the  first  thing  I  did  was  try  to  find  a  little  place  in 
the  lab  to  work.   The  little  room  which  I  had  lined  with  plywood 


249 


Gerbode:  was  occupied  by  a  dermatologist.  I  quickly  escorted  him  out  of 
the  place,  since  he  was  not  there  legally,  and  I  needed  to  have 
a  place  myself.  Furthermore,  he  wasn't  doing  any  research. 

So  I  set  up  shop  again  and  started  doing  animal  work,  the 
other  reason  being  that  I  had  no  patients.   The  clinical  work  had 
long  since  vanished  with  having  been  away  for  three  and  a  half 
years.   In  fact,  those  of  us  who'd  been  away  at  war  were  invited 
to  go  to  the  outpatient  clinic  and  help  with  the  minor  surgery  and 
with  the  students.   Eventually  we  were  put  on  the  consulting  staff 
in  the  hospital,  so  that  we  could  work  with  residents.   But  this 
took  a  while. 


Experimentally- induced  Cyanosis 


Gerbode:   Meanwhile  I  started  doing  experiments  on  the  heart  and  made  some 
dogs  cyanotic,  which  was  the  second  time  this  had  been  done 
historically,  and  published  a  few  papers  on  this  work. 

Hughes:   How  did  you  do  that? 

Gerbode:   We  transferred  the  inferior  vena  cava  from  the  right  to  the 'left 
side.   It's  kind  of  a  tricky  operation,  and  there  weren't  many 
survivors,  but  the  few  that  did  survive  were  very  cyanotic  and 
developed  all  the  signs  of  chronic  cyanosis. 

Hughes:   You  were  interested  in  the  cyanosis  rather  than  the  transplantation 
of  the  vessels? 


Gerbode:   There  were  certain  congenital  anomalies  which  could  be  corrected  if 
you  could  move  the  major  vessels  from  one  side  of  the  heart  to  the 
other.   This  proved  to  be  true  later,  when  there  were  several 
operations  to  correct  cyanosis  in  children  which  were  based  upon 
moving  the  major  vessels  from  one  side  of  the  heart  to  the  other. 
This  little  work  which  I  did  after  the  war  was  cited  rather 
extensively  by  the  Swedes  when  they  gave  me  an  honorary  degree.   I 
never  thought  they  would  dig  that  up  as  an  important  contribution. 


250 


The  Heart-Lung  Machine 


Gerbode: 


Hughes : 
Gerbode : 


Hughes: 
Gerbode: 


This  work  went  on,  and  soon  afterwards  it  became  apparent  that  a 
heart-lung  machine  would  be  the  thing  we  should  work  on,  so  that 
we  began  to  assemble  the  gear  necessary  to  do  work  with  the  use 
of  a  heart-lung  machine.   My  good  friend  Jack  Gibbon  in  Philadelphia, 
who  is  the  father  of  the  heart-lung  machine,  gave  me  our  first  pump, 
which  he  took  off  his  shelf  in  his  experimental  laboratory.   This 
was  a  roller  pump.  Later  on,  after  developing  a  machine  which 
worked  experimentally,  we  used  that  pump  on  quite  a  few  clinical 
cases. 

We  had  a  visitor,  a  very  important  faculty  member,  chief  of 
surgery,  University  of  California,  during  this  early  stage.   He 
was  curious  to  see  what  we  were  doing  about  this  machine.   He  shook 
his  head  rather  dubiously  about  the  whole  effort.   Subsequently 
another  member  of  the  University  of  California  faculty  came  over 
and  said  that  he  didn't  think  that  this  was  going  to  be  nearly  as 
good  as  using  deep  hypothermia,  because  of  the  fact  that  we  used 
so  much  blood.  Well,  we  have  used  a  great  deal  of  blood  in  this 
work,  but  not  as  much  as  we  did  originally,  and  blood  is  not  the 
factor  anyway. 

• 

What  was  the  problem  with  using  so  much  blood? 

Filling  the  heart-lung  machine  with  the  blood  to  prime  it,  and 
replacing  the  blood  lost  during  the  operation  and  postoperatively. 
However,  we  were  not  deterred  by  this.   At  this  time  I  got  Mr. 
Bramson  to  come  with  us,  because  I  felt  that  George  Clowes 
[pronounced  clues]  had  shown  that  a  membrane  oxygenator  was  a 
satisfactory  type  of  oxygenator,  and  I  wanted  Mr.  Bramson  to  work 
with  us  to  develop  [it]. 


Where  was  Clowes  working? 

He  was  working  at  that  time  at  Cleveland, 
sailor  and  a  good  friend  of  mine. 


Incidentally,  he's  a  great 


In  any  event ,  Bram  started  to  work  with  us  to  develop  an 
oxygenator,  and  eventually,  after  a  couple  of  years,  he  developed 
a  disk  type  of  oxygenator  which  I  used  in  about  three  hundred  cases. 
It  proved  to  be  difficult,  however,  for  various  reasons,  and  wasn't 
the  ideal  solution  to  the  problem. 

Did  I  say  something  about  this  before? 


251 


Hughes:   You  did,  but  I  have  a  question.   You  realized  quite  soon  that  the 

disk  oxygenator  was  not  the  optimal  machine,  but  I  believe  you  said 
that  until  the  membrane  oxygenator  was  ready,  that  you  were  prepared 
to  use — 

Gerbode:   We  had  to  use  something,  because  the  patients  were  there  and  needing 
operations,  so  we  had  to  use  whatever  we  could  get. 

Hughes:   How  many  years  did  that  go  on,  do  you  think? 
Gerbode:   About  three  or  four  years,  I  guess. 


Norman  Shumway:   Cold  Arrest  of  the  Heart  and  Heart  Transplantation 


Gerbode:   At  the  same  time  we  were  working  on  the  heart-lung  machine,  Norm 
Shumway  came  into  the  laboratory.   He  had  been  in  Minneapolis  and 
had  moved  to  California,  believing  that  he  might  find  a  place 
somewhere.   Dr.  Holman  gave  him  a  spot  in  the  laboratory  to  work. 
He  started  doing  animal  experimentation,  and  worked  mainly  on  two 
things,  cold  arrest  of  the  heart  for  open  heart  surgery,  which  is  a 
technique  which  was  used  extensively  and  then  subsequently  was 
used  in  combination  with  cold  cardioplegia  by  injecting  potassium 
solutions  into  the  base  of  the  aorta  to  stop  the  heart.   Norm  did 
not  believe  this  was  as  good  as  it  has  turned  out  to  be.   He 
thought  that  he  could  do  just  as  well  with  bathing  the  heart  in  ice 
slush.   But  most  people  now  use  ice  slush  and  cold  arrest  of  the 
heart  by  injecting  cold  solutions  containing  potassium  into  the  base 
of  the  aorta  and  prof using  the  heart  through  the  coronaries. 

The  other  thing  that  Norm  started  working  on  was  cardiac 
transplantation.   He  had  Richard  Lower  with  him.   Richard  Lower  now 
is  a  professor  of  surgery  on  the  East  Coast  and  a  very  good  one. 

Hughes:   Now,  was  heart  transplantation  in  the  wind  by  this  time? 

Gerbode:   No,  I'm  not  aware  of  it  being  a  big  item  in  any  of  the  other 
laboratories. 

Hughes:   This  is  the  early  fifties? 

Gerbode:   Late  fifties.   So  watching  Norm,  I  could  see  that  it  was  technically 
feasible  to  transplant  the  dog's  heart,  but  the  survival  rate  was 
extremely  low,  because  the  heart  was  always  rejected.   So  I  told 


252 


Gerbode:  Norm  it  was  a  great  idea  and  a  great  thing  to  do,  but  I  really 

thought  that  it  wouldn't  work  until  the  rejection  phenomenon  was 
controlled  one  way  or  the  other.   This  proved  to  be  only  partially 
true.   It's  been  shown  repeatedly  by  surgeons  that  if  they  demonstrate 
the  feasibility  technically  of  doing  a  procedure,  then  other  people 
come  in  to  show  that  they  can  back  this  up.   For  example,  when 
Dr.  Blalock  did  the  first  blue  baby  operation,  he  showed  that  you 
could  operate  on  blue  babies  and  make  them  better,  and  a  whole  host 
of  cardiologists  arose  out  of  almost  nowhere,  and  got  interested 
in  the  diagnosis  of  cyanotic  heart  disease  in  children.   It  became 
a  specialty  overnight  because  of  that. 

The  same  thing  is  true  of  Jack  Gibbon.   When  he  demonstrated 
the  feasibility  of  using  the  heart-lung  machine,  there  was  a  great 
flurry  of  activity  everywhere  to  produce  another  type  of  heart-lung 
machine  that  was  simpler  than  the  one  he  had  devised. 

Hughes:   Isn't  it  true  that  there  was  quite  a  bit  of  transplantation  going 
on  before  many  inroads  had  been  made  in  the  understanding  of 
rejection? 

Gerbode:  Yes.  The  thing  that  they  tried  to  do,  and  still  do,  is  tissue 

typing.   In  other  words,  the  closer  you  get  to  matching  the  patient's 
tissue,  the  better  the  result  is.   This  has  been  proven  particularly 
in  kidney  transplants.   But  this  wasn't  the  final  answer. 

Hughes:   Was  tissue  typing  well  developed  when  transplantation  first  began? 

Gerbode:  No,  it  wasn't,  but  as  soon  as  kidney  transplants  became  feasible, 
then  tissue  typing  became  another  speciality  which  arose  from 
nowhere,  you  might  say.   Men  developed  laboratories  to  study  this 
and  apply  the  techniques  to  human  organ  transplantation. 

Hughes:   There  was  a  drug  related  component,  too. 

Gerbode:   The  drugs  came  later.   Of  course,  a  great  deal  of  research  was  done 

to  find  drugs  that  would  control  the  immune  reaction.   So  now  we  have 
several  drugs  which  are  being  used.  No  drug,  however  is  without 
its  bad  effects.  You  can't  even  take  an  aspirin  without  losing 
something.   However,  the  pluses  are  much  greater  than  the  minuses. 

I  must  say  that  I  was  rather  pessimistic  about  the  outlook  for 
cardiac  transplantation.   But  Norm  was  extremely  persistent  and 
worked  terribly  hard,  and  finally,  as  everyone  knows,  did  some 
cardiac  transplantations  at  Stanford  after  the  medical  school  moved. 


253 


Gerbode:   The  interesting  story  about  Christiaan  Barnard,  who  did  the  first 
heart  transplant,  is  that  he  was  visiting  Lower's  clinic  on  the 
East  Coast  and  saw  Lower  doing  cardiac  transplantation  in  animals. 
He  had  actually  gone  there  to  study  kidney  transplantation,  but  when 
he  saw  Lower  do  the  cardiac  transplant  in  the  animal,  he  said,  "I'm 
going  to  try  that  when  I  get  home."  So  he  went  back  to  South  Africa 
and  practiced  on  a  few  dogs,  all  of  which  I  think,  did  not  survive, 
but  he  finally  did  a  cardiac  transplant,  the  first  in  the  world, 
very  successfully.   But  the  only  reason  he  did  it  was  that  he  had 
watched  Lower  do  it  and  used  the  technique  which  Lower  and  Shumway 
had  developed. 

This  was  extremely  embarrassing  to  the  research  effort  in  the 
United  States,  and  very  quickly  after  Barnard  did  that  cardiac 
transplantation  successfully,  a  great  deal  of  money  was  poured  into 
research  in  this  country. 

Hughes:   Was  that  one-upmanship? 

Gerbode:   Yes.   It's  like  Australia  winning  the  America  Cup  [in  sailing].   Now 
there's  going  to  be  feverish  activity  to  develop  a  boat  to  bring  it 
back  again.   [laughter]   Millions  more  dollars  will  be  spent  doing 
it. 


Hughes:    But  Barnard  had  some  contact  with  Stanford  as  well,  didn't  he? 

Gerbode:   Well,  he  did  later  on,  but  the  first  exposure  was  with  Lower.   Norm 
had  not  done  any  clinical  cases  up  till  that  point.   As  soon  as 
Barnard  did  one — in  fact,  he  did  another  one  shortly  afterwards — 
then  there  was  such  excitement  in  the  world  that  it  made  it  a  lot 
easier  for  Shumway  to  try  it  on  humans,  which  he  then  did.   And  he 
began  to  be  more  successful  than  anybody. 

Hughes:   And  Lower  did  the  same? 

Gerbode:   Lower  has  done  the  same.   Now  cardiac  transplantation  is  done  in 
many  centers  in  the  world. 

Hughes:   Were  they  using  any  immunosuppressant  drugs? 

Gerbode:   Not  in  the  very  beginning.   One  of  our  most  vocal  and  widely 

publicized  surgeons  in  the  South  said  to  me  once,  "There's  no  use 
trying  to  type  these  hearts  or  anything  like  that.   Just  transplant 
the  heart.   That's  the  only  thing  to  do."  Well,  all  of  his  patients 
died,  every  single  one.   He's  the  same  person  who  said,  "You  don't 
need  to  protect  the  heart.   Just  clamp  the  aorta  and  do  the  operation. 


254 


Gerbode:   Let  the  heart  quiet  down.  You've  just  got  to  be  fast."  But 

then  later  on  he  described  what  is  called  the  "stone  heart,"  [which] 
is  simply  a  heart  that's  been  made  dead  from  ischemia,  in  other 
words,  rigor  mortis  of  the  heart.   But  he  didn't  recognize  it  as 
such. 

Hughes:    Sounds  like  an  unusual  technique. 

Gerbode:  Well,  he's  got  a  tremendous  ego  and  he  thinks  he  can  say  and  do 
anything.   Actually  his  approach  has  been  very  successful  with 
doctors  and  [patients] ,  because  his  clinic  is  flooded  with  patients 
all  the  time. 

Hughes:  Because  of  the  bravado? 

Gerbode:  Yes.   And  he's  a  good  surgeon. 

Hughes:  But  I  should  think  the  mortality  rate  would  put  people  off. 

Gerbode:  It's  not  bad. 

Hughes:  Now. 

Gerbode:  Now  [that]  he's  adopted  everybody  else's  technique. 


Dieners 


Gerbode: 


Hughes: 
Gerbode: 


There  was  a  fellow  by  the  name  of  John  Kratch,  a  German,  who  ran 
that  surgical  laboratory  [at  the  Institutes  of  Medical  Sciences] 
for  years  and  years.   He  was  just  an  absolute  slave  to  the  people 
who  were  doing  the  research  there.   He  could  set  up  almost  any 
experiment  for  you.   Later  on  he  trained  another  Jewish  German 
refugee  by  the  name  of  Ludwig,  and  Ludwig  carried  on  when  John  got 
too  old.   Ludwig  was  equally  good.   Ludwig  then  trained  Madelaine 
Petillo,  who  is  a  fantastic  French  girl,  and  Don  Toy,  who  is 
Chinese.   Those  two  carried  the  laboratory  spirit  on  until  the 
early  '70s  with  our  new  lab. 

Is  it  just  chance  that  all  these  people  are  foreign? 

It's  hard  to  find  people  to  do  this  kind  of  work.   We  have  Americans 
now  doing  experimental  surgery  in  all  these  labs. 


Hughes: 
Gerbode: 


Hughes : 


Gerbode: 


255 


But  in  most  cases  these  people  merely  set  up  the  operation, 
didn't  actually  participate,  did  they? 


They 


In  some  cases  [in  other  laboratories]  they  would  conduct  the 
experiment  after  it  had  been  established.   We  didn't  do  it  that 
way.   We  did  all  of  our  own  experiments,  but  they  would  set  up  the 
animal  and  get  the  equipment  ready  and  prepare  blood  if  it  were 
necessary. 

When  the  diener  did  the  experimental  work,  would  that  be  noted  in 
the  paper? 

Sometimes,  sometimes  not.   It  just  depends  on  the  person.   We  always 
used  summer  students  in  the  laboratory,  and  some  of  them  have  gone 
on  to  have  quite  distinguished  careers.   A  professor  of  surgery  at 
Davis  was  one  of  our  summer  students.   Actually  Lower  was  a  summer 
student,  too,  way  back.   We  had  another  summer  student  with  a  degree 
in  biomedical  engineering  from  Stanford;  he  went  to  medical  school 
at  Cornell,  and  by  the  time  he  got  established  there  he  could  do 
better  research  than  the  members  of  the  regular  department ,  so  the 
professor  gave  him  a  lab. 


The  Artificial  Heart* 


Hughes:   Would  you  comment  on  the  artificial  heart? 

Gerbode:   The  National  Institutes  of  Health  decided  that  there  was  going  to 
be  a  great  need  for  the  artificial  heart  in  the  future,  so  they 
funded  [seven  or  eight]  centers  to  develop  the  artificial  heart, 
either  a  left  heart  or  a  whole  heart.   The  biggest  funding  went  to 
Kolff  in  Salt  Lake.   A  lot  of  the  money  was  given  to  him  because 
he'd  done  such  a  good  job  with  developing  artificial  kidneys. 

Don  Hill,  who  was  then  one  of  my  assistants,  got  one  of  the 
grants  to  develop  a  left  heart  bypass  which  was  [a  device]  to  take 
over  the  work  of  the  left  heart  when  it  was  failing.   He  worked  in 
the  lab  here  in  San  Francisco  with  a  company  called  Thorotek,  and 
got  to  the  point  where  they  were  doing  pretty  well  with  experimental 
animals.   Then  Thorotek,  being  a  private  company  in  which  Dr.  Hill 


*See  the  session  recorded  on  4/23/84,  pp.  341-342. 


256 


Gerbode:  was  a  major  investor,  wanted  to  do  more  testing  privately  and  to 
use  our  laboratories.   Well,  quite  a  few  of  us  didn't  think  [it] 
was  a  proper  use  of  the  laboratory  for  a  private  company  to  come 
in  and  use  the  lab  for  their  own  economic  benefit.   So  they 
finally  set  up  their  own  shop  in  Berkeley,  and  they  now  have  a 
rather  big  lab  over  there  where  they  do  testing  of  various  devices. 
I  believe  they  still  have  a  government  contract  to  work  on  the  left 
heart  bypass. 

Hughes:   How  would  a  left  heart  bypass  be  used? 

Gerbode:   It  has  to  have  the  same  arrangement  that  the  artificial  heart  has 
at  the  present  time.   It's  a  pump  activated  by  air  or  fluid,  which 
squeezes  a  small  chamber  containing  blood,  like  a  small  heart.   You 
squeeze  it  from  the  outside  and  make  it  pump  that  way,  and  that 
synchronized  with  the  electrocardiogram.   But  then  it  requires  a 
tube  coming  out  of  the  chest,  which  is  the  problem  with  the  total 
heart  as  well,  as  was  demonstrated  by  the  man  in  Salt  Lake  [Barney 
Clark  who  received  an  artificial  heart  in  1983] .   So  the  left  heart 
bypass  is  conceived  mainly  to  take  over  a  failing  left  ventricle 
as  a  temporary  adjunct,  until  that  left  heart  recovers.   It  hasn't 
been  used  clinically  very  much.   There  are  a  few  places  that  have 
tried  it. 

• 

Hughes:   It's  used  in  conjunction  with  the  human  heart. 

Gerbode:  Yes,  it's  attached  to  the  heart,  and  functions  like  a  left  heart. 

Hughes:   In  developing  these  devices,  there  seem  to  be  two  schools  of  thought, 
one  school  being  the  anatomical  school,  where  the  aim  is  to  make 
the  mechanical  device  as  close  to  nature  as  possible ,  and  the  other 
school,  which  tries  to  make  an  efficient  device,  regardless  of 
whether  it  mimics  nature  or  not.   In  developing  these  artificial 
hearts,  which  way  has  it  gone? 

Gerbode:  The  artificial  heart  is  a  combination  of  artificial  valves,  which 
usually  are  mechanical  valves,  although  some  use  pig  valves.  The 
rest  of  the  device  is  pure  mechanics  and  electricity. 

Hughes:   So  it  looks  nothing  like  the  human  heart. 

Gerbode:   It  is  like  the  human  heart  in  that  it  is  designed  to  pump  the  same 
amount  of  blood  as  the  human  heart  would.   It  has  to,  to  be  a 
replacement. 

Hughes:   Does  that  mean  that  each  artificial  heart  has  to  be  tailor-made 
to  the  individual  recipient? 


257 


Gerbode:   No.   We  know  pretty  well  the  spectrum  of  volume  which  the  heart 
needs  to  pump  for  an  adult.   If  you  put  a  heart  in  within  that 
sort  of  volume  load  or  output,  it'll  work  all  right. 

Hughes:   What  do  you  think  are  the  chances  of  developing  an  artificial 
heart  that  really  will  sustain  life  for  many  years? 

Gerbode:   I  think  it  will  eventually  come,  but  the  main  problem  is  how  to  keep 
it  running  without  having  a  tube  come  out  the  chest  wall.   Of  course 
they're  trying  to  use  nuclear  energy  to  do  this,  but  the  heat  exchange 
involved  with  this  is  something  that  hasn't  been  solved  yet. 


Targeted  vs.  Basic  Research* 


Hughes:   You  mentioned  that  NIH  made  a  decision  at  some  point  to  fund  the 
artificial  heart.   How  does  NIH  decide  that  now  is  the  time  to 
support  some  new  procedure? 

Gerbode:   They  bring  up  various  questions  like  this  periodically.   They 

usually  have  a  panel  of  experts  come  to  Washington;  they  sit  around 
and  discuss  it,  and  they  say,  what  is  the  most  important  thing  we 
should  be  spending  our  money  on  in  the  country?   [NIH]  usually 
listen  to  the  panel.   Some  of  the  conclusions  are  presented  -to 
Congress.  One  of  the  best  ways  to  get  a  certain  kind  of  research 
started  is  to  have  a  congressman  or  a  president  get  one  of  these 
diseases.   In  the  Kennedy  family  there  was  a  child  born  with  a 
mental  disease,  so  when  Kennedy  was  president  there  was  a  great  deal 
more  money  put  into  research  in  mental  health.   When  Eisenhower  got 
a  stroke,  the  same  thing  happened.   They  had  to  study  arteriosclerosis 
more,  so  money  was  put  into  arteriosclerosis.   And  this  happened 
when  Lyndon  Johnson  got  a  coronary.   No  objection  to  that.   You  have 
to  have  some  reason  for  doing  something. 

Hughes:    Some  people  object,  though,  to  this  extremely  targeted  research, 
I  think  on  the  principle  that  sometimes  a  very  goal  oriented  type 
of  funding  isn't  very  successful. 

Gerbode:   I  think  both  have  to  be  done.   I  think  targeted  research  is  necessary. 
I  think  pure  research,  which  doesn't  have  a  target  but  is  involved 
with  basic  problems  of  biology,  will  periodically  produce  perhaps  even 


*See  the  session  recorded  on  4/23/84,  pp.  342-344. 


258 


Gerbode:   greater  things.   But  it  takes  a  long  time  for  it  to  rise  to  the 
surface.  You  take  the  whole  business  of  antibiotics.  After 
[Sir  Alexander]  Fleming  discovered  penicillin,  there  was  enormous 
targeted  research  in  antibiotics.  Now  we  have  dozens  of  antibiotics, 
all  targeted  research,  but  mainly  done  by  drug  companies,  because 
there's  so  much  money  involved. 

fl 

Gerbode:   Some  big  company  or  individual  will  profit  by  the  research 

eventually.  Eventually  the  public  has  to  profit.   Nobody  will 
profit  unless  some  good  is  being  done.   If  somebody  knows  how  to 
dig  a  better  hole  to  find  oil,  he  should  be  compensated  for  it. 
There  always  is  an  argument  going  on  in  higher  circles  about  so- 
called  basic  research  versus  targeted  research,  but  I  think  there's 
a  great  place  for  both. 

Our  research  at  the  present  time  in  my  institute  is  mainly 
concerned  with  immunology.   We're  targeting  on  the  rejection 
phenomenon  and  on  how  to  juggle  the  body's  physiological  reactions 
so  that  we  can  control  the  rejection  phenomenon  better. 

Hughes:   And  you  chose  that  to  target  because  of  its  importance? 

Gerbode:   I  chose  it  because  there  is  a  great  deal  of  interest  in  immunology 
so  there's  money  available  to  do  the  research,  and  I  think  it's 
one  of  the  big  frontiers.  We  also  have  the  laboratories  and  the 
people  who  can  do  it. 

Hughes:   Good  reasons. 

Gerbode:   There's  no  use  our  spending  our  present  major  effort  on  developing 
the  heart-lung  machine.   There  are  things  which  we  can  use  the 
heart-lung  machine  for  in  research  which  will  add  to  our  knowledge 
about  other  things.   This  is  being  done  in  various  places  in  the 
world. 


Legal  and  Ethical  Aspects  of  Medicine* 


The  Legal  Aspect 


Gerbode:  Right  now  this  country  is  litigiously  minded,  because  we've  got 
so  many  hungry  lawyers  who  get  vast  sums  of  money  for  winning  a 
case,  that  you  have  to  explain  every  serious  operation  to  the 


259 


Gerbode:   patient  and  tell  [him]  this  might  happen,  that  might  happen,  and 
document  the  explanation.   For  example,  here  in  San  Francisco 
recently  one  of  the  heart  surgeons  was  sued  for  over  a  million 
dollars  and  lost  the  suit  because  he  didn't  tell  the  patient  that 
there  might  be  a  certain  complication.   The  complication  occurred, 
and  he  was  sued.   You  can't,  obviously,  tell  [paitients]  every 
possible  complication;  otherwise  nobody  would  want  to  have  an 
operation.   But  you  have  to  more  or  less  cover  the  major  ones. 

The  whole  question  of  the  medical-legal  aspects  of  the  practice 
of  medicine  is  a  mess  at  the  present  time.   No  good  surgeon  can 
practice  without  being  sued. 

Hughes:   How  recent  a  phenomenon  is  this? 

Gerbode:   It's  been  developing  for  twenty  years.   The  main  thing  is  that 

contingency  fee  which  lawyers  get.   They'll  say,  "Sure,  we'll  sue  for 
a  million  dollars,  and  my  fee  is  40  percent  of  whatever  we  get, 
and  you  have  to  pay  the  expenses  of  everything  as  we  go  along." 
One  of  our  famous  laywers  here  in  San  Francisco  has  his  wall 
decorated  with  facsimile  copies  of  the  checks  he's  received.   Instead 
of  hanging  up  trophys  shot  in  Africa  or  something,  he  has  framed 
copies  of  checks. he's  received  for  medical  malpractice. 

Hughes:   How  has  this  all  affected  innovative  surgery? 

Gerbode:   It  makes  medicine  much  more  expensive,  because  you  have  to  do  so 
many  tests  to  be  sure  somebody  won't  sue  you  because  you  haven't 
done  a  test.   You  take  more  xrays;  you  do  more  laboratory 
investigations.  You  have  to  be  extremely  careful  if  you're  doing 
an  operation  that  you  don't  do  something  that  is  even  the  slightest 
bit  out  of  common  practice.   It's  all  right  if  it  works,  but  if  it 
doesn't  work  you're  in  trouble. 


The  Ethical  Aspect 


Hughes : 


Gerbode: 


I'm  interested  in  the  development  of  the  various  ethical  procedures 
that  now  limit  medical  practice  in  virtually  all  fields.   I  was 
wondering  if  you  could  remember  when  things  began  to  tighten  up. 
Was  it  right  after  the  war? 


Yes,  soon  after  the  war,  I  think, 
development. 


There's  been  a  crescendo 


260 


Hughes:   Were  the  Nuremberg  trials  something  that  the  medical  profession 
really  took  note  of  and  said,  we've  got  to  adopt  some  of  these 
regulations  into  our  own  practice? 

Gerbode:  Well,  we  had  to  be  more  careful.   That  certainly  is  true. 

Hughes:   But  at  that  point  [1946]  it  was  really  up  to  the  individual.   The 
government  hadn't  stepped  in. 

Gerbode:  That's  right.   This  was  up  to  the  individual  and  the  courts. 

Hughes:   Prior  to  that  it  had  been  very  much  up  to  the  individual  physician 
how  much  or  how  little  he  informed  the  patient,  is  that  not  true? 

Gerbode:  Right.   In  many  instances  they  didn't  inform  [patients]  very  much 
of  anything,  and  in  Europe  they  still  don't.   In  England,  for 
example,  the  contingency  fee  for  lawyers  is  against  the  law,  and 
it's  against  the  law  in  Canada,  too.   Therefore  malpractice 
insurance  is  very  low.   So  [if]  the  patient  needs  to  have  a  stomach 
operation,  he  believes  the  doctor  is  going  to  do  a  good  job,  because 
he's  in  a  good  hospital  and  he's  got  a  good  name,  but  the  doctor 
doesn't  tell  him  everything  that  might  happen. 

Hughes:   In  the  prewar  days  were  patient  consent  forms  required? 
Gerbode:  Not  generally. 

Hughes:   The  whole  structure  of  peer  review  and  the  labyrinthian  contortions 
that  the  government  now  requires  a  physician  to  go  through  is  a 
relatively  recent  development,  is  it  not — the  late  '60s? 

Gerbode:   It  developed  in  the  '50s,  too. 

Hughes:   Do  you  remember  what  the  provocation  was? 

Gerbode:   I  think  the  provocation  came  because  the  lawyers  found  they  could 
influence  the  juries  to  make  favorable  verdicts,  and  they  worked 
very  hard  on  it  because  they  were  making  so  much  money  from  it. 


Malpractice  Suits* 


Hughes:   Have  you  ever  been  involved  in  a  malpractice  suit? 


*See  the  session  recorded  on  7/17/84,  pp.  445-455,  for  an  extensive 
discussion  of  malpractice  and  related  issues,  including  the 
celebrated  Salgo  case. 


261 


Gerbode:   Oh  sure.   I've  never  lost  one,  but  I've  been  sued  three  times.   A 
lot  of  people  sue  thinking  that  maybe  you'll  get  scared  and  not 
want  publicity  and  try  to  settle,  just  to  avoid  the  difficulty  of 
going  to  court.  But  if  people  want  to  sue  me,  they're  in  for  a 
tough  battle.   [laughter]   Two  [suits]  were  dropped.   Actually, 
they  were  really  just  nonsense  suits  to  try  to  get  me  to  settle. 

One  suit,  the  Salgo  case,  we  lost  in  the  first  round,  a  suit 
in  which  my  involvement  was  simply  to  write  a  request  for  a 
procedure  to  be  done.   I  didn't  do  the  procedure.   But  during  the 
procedure  a  bad  result  came  about.   The  doctrine  of  res  ipse  loquator 
applied.   In  other  words,  the  fact  speaks  for  itself" It  was  a 
very  fundamental  suit,  and  it's  a  famous  case.   It  was  printed  word 
for  word  in  the  Journal  of  the  American  Medical  Association.   It 
involved  a  question  of  residency  training  and  writing  orders  and 
having  residents  do  things  by  order.   The  appellate  court  threw 
the  case  out.   They  said  it  was  nonsense. 

Hughes:   Was  the  suit  against  you? 

Gerbode:   Against  me  and  Stanford  University,  the  xray  department,  and  several 
of  the  men  who  were  working  as  residents  at  the  time. 

Hughes:   Who  supposedly  had  not  carried  out  their — 

f 

Gerbode:   They  tried  to  find  that  [the  residents]  had  done  the  test 

erroneously,  but  they  did  not  do  the  test  erroneously.   It's  just 
that  the  patient  was  so  badly  off  that  he  had  a  bad  result. 


The  Legal  Aspect  (Continued) 


Hughes:    I  don't  think  patients  in  general  are  well-served  by  having  such  a 
lopsided  system  that  seems  to  be  so  heavily  in  favor  of  the  legal 
people. 

Gerbode:   It's  really  bad.   It  interferes  with  everything  you  do  everyday. 
You  have  to  be  so  careful  that  you  probably  sometimes  don't 
deliver  the  first-class  medicine  the  patient  should  have. 

Hughes:    It's  not  just  the  medical  profession  that's  affected  either;  look 
at  the  hassle  that  the  drug  industry  has  to  go  through  and  the 
consequent  cost  of  their  products. 


262 


Gerbode:   The  whole  product  business  is  in  a  state  of  chaos  because  the  lawyers 
found  they  could  make  pots  of  money,  too,  by  suing  people  making 
instruments  and  devices. 

Hughes:   How  can  the  pendulum  be  forced  back? 

Gerbode:   I  think  if  they  just  struck  out  the  contingency  fee,  that  would  stop 
90  percent  of  it.   But  you  know  the  reason  they  can't  do  it?  Because 
all  the  judges  and  people  involved  are  lawyers,  too. 


Medical  Ethics  Committees 


Hughes:   A  quick  question  about  medical  ethics.  Did  you  ever  have  any  role, 
either  on  a  national  level  or  in  the  hospital  here ,  in  defining 
bioethical  procedures? 

Gerbode:  No,  I  didn't.   I  wasn't  even  on  the  committees. 
Hughes:   Was  that  just  chance? 

Gerbodes   I  suppose  so.   Most  of  these  things  were  determined  on  a  national 

level,  and  then  you'd  more  or  less  follow  the  established  protocols 
in  your  local  hospital. 

Hughes:   What  is  the  procedure  at  Presbyterian? 

Gerbode :  We  advocate  informed  consent .   In  other  words ,  we  advocate  that  the 
medical  or  surgical  doctor  should  explain  to  the  patient  the  nature 
of  his  illness  and  what  kind  of  treatment  is  planned  or  rendered, 
with  the  possibilities  of  complications. 

Hughes:   So  you  don't  have  to  make  a  presentation  to  a  committee  when  you're 
starting  off  on  a  new  procedure? 

Gerbode:   Yes,  you  do.   We  have  a  committee  to  whom  you  have  to  submit  any 
new  device  or  radical  new  procedure.   It  is  called  the  committee 
on  human  experimentation  [and  is]  composed  of  doctors,  research 
people,  and  trustees.   It  shouldn't  be  called  that  because  it 
sounds  bad. 

Hughes:   They're  all  in-house  people? 

Gerbode:   In-house  people,  but  one  or  two  outsiders.   Every  hospital  has  one 
of  these  committees  now. 


263 


Hughes:   All  of  those  committees  are  following  the  NIH  guidelines? 
Gerbode:   More  or  less.   The  NIH  guidelines  influence  their  decisions. 

Hughes:  But  the  way  you  just  phrased  it,  it  made  me  think  that  there  is  a 
bit  of  leeway  in  interpretation.  From  hospital  to  hospital  there 
might  be  slight  variations? 

Gerbode:   Yes,  some  hospitals  are  extremely  strict,  and  others  are  lenient. 
It  depends  on  their  committee.   However,  it  gives  the  doctor  a 
very  good  basis  for  trying  or  doing  something,  if  the  committee  has 
approved  it. 

Hughes:   What  is  the  reputation  of  Presbyterian  on  that  scale? 

Gerbode:   They're  very  reasonable  about  it.   We  have  a  lot  of  research  going, 
so  that  the  problems  do  come  up  fairly  frequently,  and  they  have 
to  be  fairly  knowledgeable  and  intelligent  about  it. 

Hughes:   You  mentioned  the  surgeon  from  the  South  who  will  remain  nameless 

and  his  rather  unusual  ideas.   How  did  he  get  away  with  that  in  light 
of  human  use  committees? 

Gerbode:   I  once  had  a  patient  of  his  in  whom  one  of  his  valves  failed.   I 

had  to  operate  upon  this  patient  in  the  middle  of  the  night  and  put 
another  valve  in.   I  called  [the  surgeon]  up  and  told  him  about  it. 
I  said,  "You'd  better  be  prepared,  because  this  fellow  I  think  may 
want  to  sue  you."  He  said,  "Well,  he'll  just  have  to  stand  in  line." 

Hughes:   Well,  that's  a  different  attitude! 


Research  vs.  Patient  Benefit 


Hughes:    From  talking  to  you  all  these  sessions,  I  know  that  research  is 
very  dear  to  your  heart ,  and  I  believe  that  taking  care  of  your 
patients  is  as  well.   At  times  those  two  aspects  are  in  conflict. 
I  mean,  the  research  oriented  person  is  trying  to  break  through  to 
new  information.   The  physician  is  looking  after  his  patients  to  the 
best  of  his  ability.   Have  you  ever  had  problems  in  reconciling 
those  two? 


264 


Gerbode:  No,  I  don't  think  so.   If  you're  on  a  frontier,  as  we  were  in  the 
very  beginning,  you  simply  would  sit  down  with  the  family  and 
discuss  the  whole  thing.   Here  are  the  possibilities.   You  can  do 
this  or  that  or  the  other  thing,  or  do  nothing.   There  are  very 
good  statistics  on  virtually  every  disease  at  the  present  time, 
so  that  you  can  say  the  life  expectancy  under  certain  circumstances 
with  this  disease  is  this.  And  it  might  be  this,  if  we  try  to  do 
something.   I  never  thought  1  was  really  experimenting  on  patients. 
I  was  always  applying  something  which  I  thought  was  ready  to  be 
applied  to  human  beings,  because  it  might  be  better  than  what  was 
available. 

Hughes:   Did  you  ever  operate  with  the  idea  of  providing  a  technique  which 
would  benefit  patients  in  general  but  perhaps  not  the  specific 
patient  that  you  were  operating  upon? 

Gerbode:  Well,  I  suppose  so.   I'd  have  difficulty  finding  the  exact  operation 
where  this  might  apply.   The  whole  question  of  developing  our 
monitoring  system,  using  the  computer,  that  was  new  when  we  started 
it,  and  we  obviously  were  testing  and  experimenting  on  patients 
every  minute.   But  there  wasn't  any  risk  involved.  We  were  simply 
measuring  something.  We  found  out  which  things  we  could  measure 
the  best,  and  which  would  give  us  the  best  information  for  a  patient 
or  his  disease. 

Hughes:   In  those  early  days  with  the  monitoring  system,  were  you  backing 

up  the  computer  monitoring  with  the  old  methods  of  doing  the  testing 
to  check  the  computer  methods  out? 

Gerbode:   Yes,  we  did  that.   But  you  know,  there  were  so  many  exciting  things 
about  it,  to  be  able  to  sit  there  or  have  the  nurse  sit  there  and 
read  off  these  data  on  the  patients  and  make  a  decision.   Previously 
they  had  to  go  through  a  chart  full  of  papers  and  scribbled  notes 
to  make  the  decision.   The  nurse  would  put  lab  reports  which  were 
stuck  on  little  bits  of  paper  in  the  chart  somewhere,  and  you'd 
have  to  go  through  the  chart  to  find  them.  After  we  developed  this 
[computer  monitoring]  technique,  the  laboratory  put  them  right  in 
the  patient's  computer  record,  so  the  nurse  pushed  a  button  and 
there  it  all  was  right  in  front  of  her.   Furthermore,  at  the  end  of 
everyday  there  was  a  printout  of  all  that  data,  which  was  then  put 
in  the  patient's  chart. 

Hughes:   Does  every  hospital  use  computerized  monitoring  now? 

Gerbode:  Oh  no.   it's  expensive,  and  it's  more  applicable  to  hospitals  that 
are  doing  rather  complicated  work. 


265 


The  Doctor-Patient  Relationship 


Hughes:   Patient  relationships.   You  spoke  of  having  to  keep  a  certain 

distance  from  patients,  although  you  didn't  put  it  quite  that  way. 
I  was  wondering  what  type  of  relationship  you  sought  to  establish? 

Gerbode:   I  always  tried  to  seek  a  relationship  in  which  the  patient's 

family  or  the  patient,  or  both,  would  understand  what  I  was  trying 
to  do. 

Hughes:   As  simple  as  that. 

Gerbode:   Yes.   I  would  always  try  to  tell  them  that  other  doctors  would 
be  helping,  so  that  they  wouldn't  see  somebody  working  on  the 
patient  and  not  understand  why  he  was  there. 

Hughes:   Did  you  ever  find  it  difficult  not  to  become  personally  involved? 
I'm  thinking  particularly  of  the  early  surgery  on  children. 

Gerbode:   No.   The  children's  parents  were  virtually  all  very  receptive  to 
explanation  and  the  desire  to  do  what  was  right  for  the  child  to 
make  the  child  better.   I  think  that  certainly  you  have  to  develop 
an  attitude  in  which  patients  [and]  the  relatives  trust  you.   I 
think  mostly  they  thought  I  was  alwr.ys  honest ,  not  given  to  false 
hoods. 


Patient  Referral 


Hughes:   You  spoke  of  having  problems  in  the  early  days  concerning  patient 
referral,  and  that  your  practice  had  been  pretty  much  taken  over 
by  the  people  that  didn't  go  off  to  war.   But  after  that,  when  you 
began  to  make  your  name  in  surgery,  was  it  by  virtue  of  your  name 
that  you  received  most  of  your  patient  referrals? 

Gerbode:   No,  I  think  we  got  a  lot  of  patients  because  we  demonstrated  that 
we  could  treat  them  successfully.   One  reason  that  I  could  treat 
them  so  successfully  at  that  time  and  was  ahead  of  a  great  many 
people  was  because  I'd  had  so  many  years  in  the  experimental 
laboratory,  where  I'd  been  trying  out  techniques  repeatedly  on 
animals.   People  who  are  against  animal  experimentation  just  don't 
know  what's  going  on  in  the  world. 


266 


Medical  Uncertainty 


Hughes:   Medicine,  and  of  course  I  include  in  that  surgery,  is  by  scientific 
standards  a  very  uncertain  field.   There  are  so  many  aspects  to 
medicine  that  can't  be  properly  measured.   In  the  case  of  surgery, 
one  often  doesn't  know  exactly  what  one  is  going  to  find  when  the 
initial  incision  is  made.   How  did  you  cope  with  this  uncertainty? 

Gerbode:   I  guess  it's  a  matter  of  your  training.   Surgery  is  an  art  as  well 
as  a  science.  You  can  apply  your  knowledge  in  basic  training  to 
any  situation  when  it  is  presented  to  you,  and  you  try  to  solve 
the  problem  based  on  your  knowledge  and  your  ability.   Oh,  there  are 
always  surprises.   But  you  cope  with  the  surprises  with  the  training 
and  the  equipment  and  the  knowledge  you  have.  And  if  it's  very 
unusual,  you  publish  it  so  that  other  people  will  be  aware  that 
this  [problem]  might  occur. 

Hughes:   A  book  on  organ  transplantation  by  an  historian  of  medicine  and  a 
sociologist  of  medicine  describes  transplant  surgeons  as  having 
"the  courage  to  fail."*  The  point  is  that  in  order  to  push  a  field 
ahead,  you  have  to  be  willing  to  have  some  setbacks.   Would  you 
characterize  yourself  in  that  way? 

Gerbode:   I  think  yes,  because  the  whole  field  of  open  heart  surgery  was 

very  tenuous  in  the  beginning.  The  first  time  you  looked  inside  a 
living  heart  was  quite  different  from  looking  at  it  in  the  autopsy 
room  or  in  a  pickled  state  in  the  laboratory.  So  you  had  to  learn 
all  these  things,  and  [there  were]  many  surprises.  You  had  to  cope 
with  these  surprises  based  on  your  ability  and  your  knowledge. 

Hughes:   Were  the  surprises  functional  as  well  as  anatomical? 

Gerbode:   Oh  yes.  Many  times  you'd  operate  on  a  heart  and  not  know  for 
sure  what  exactly  you  were  going  to  find. 


New  Diagnostic  Techniques  in  Cardiology 


Hughes:   I  was  wondering  when  radioactive  imaging  came  into  relatively  common 
use  and  what  kind  of  impact  it  made  on  diagnosis? 


*Renee  C.  Fox  and  Judith  P.  Swazey,  The  Courage  to  Fail:   A  Social 


View  of  Organ  Transplants  and  Dialysis,  Chicago: 
Chicago  Press,  2nd  ed. ,  1978. 


University  of 


267 


Gerbode:   It's  just  really  being  applied  now.   It's  relatively  new,  and  it 
certainly  is  another  tool  to  show  how  various  parts  of  the  heart 
function.   It's  very  useful  in  determining  how  much  damage  has 
occurred  from  a  myocardial  infarction,  a  so-called  heart  attack. 
You  can  also  use  imaging  to  determine  how  well  the  heart  is 
contracting  and  performing.   There  are  a  whole  host  of  tests  that 
are  coming  up  which  are  going  to  revolutionize  [diagnosis]. 
Nuclear  magnetic  resonance,  for  example,  is  going  to  make  certain 
diagnoses  much  more  accurate. 

Hughes:    Because  you  can  visualize  exactly  what's  going  on. 

Gerbode:   Particularly  inside  the  skull.   You  can  find  out  all  kinds  of  things 
about  the  brain  with  NMR  that  you  can't  find  out  so  well  with  other 
techniques,  and  you  don't  have  to  inject  anything. 

Hughes:   So  there's  no  risk. 

Gerbode:  No  risk  at  all. 

Hughes:    But  with  radioisotope  imaging — 

Gerbode:   There  is  a  little  risk,  but  it's  not  very  much.   You  have  to  inject 

something . 

» 

Hughes:    Is  it  technetium  that's  mainly  used? 

Gerbode:   Technetium  is  one. 

Hughes:   Now,  those  techniques  would  be  handled  by  a  cardiologist? 

Gerbode:   Yes,  that's  all  cardiology.   The  surgeons  don't  get  involved  with 
this,  except  they  can  ask  for  a  test  [to]  be  done. 

Hughes:   Would  you  be  required  to  read  the  test? 

Gerbode:   Not  necessarily.   But  a  good  surgeon  will  read  the  test,  because 

[he]  can  decide  better  whether  [he]  can  cope  with  it  surgically  if 
[he's]  seen  how  the  organ  is  performing. 

Hughes:   As  you  may  know,  the  Anger  scintillation  camera  was  developed  at  U.C. 
Berkeley  by  Hal  Anger.   Did  you  ever  use  one  or  have  any  contact 
with  one? 

Gerbode:   They  have  used  them  in  cardiology  here.   I  didn't  have  any  particular 
use  for  them  myself. 


268 


Teaching 


Hughes:   Has  teaching  been  an  important  part  of  your  career? 

Gerbode:   I  like  to  teach.   When  I  was  full-time  faculty  in  the  medical 

school,  I  really  enjoyed  teaching.   I  enjoyed  lecturing.   I  enjoyed 
bedside  teaching,  the  Oslerian  method  of  teaching.   I  guess  I've 
done  my  share  of  it.   But  I  think  the  best  thing  I  did  in  teaching 
was  to  train  these  young  surgeons  to  do  heart  surgery.  As  I 
mentioned  before,  I  had  eighty-six  fellows  in  my  program  over  the 
years,  and  sixty-three  of  them  currently  are  very  active  in  heart 
surgery  in  their 'countries  [of  origin]  or  in  this  country. 

Hughes :   That ' s  quite  a  record .  What  would  you  say  is  your  most  important 
contribution  to  surgery? 

Gerbode:   I  think  training  these  young  men. 


269 


VIII  PHILANTHROPY,  FAMILY  AND  RECREATION 

[Interview  11:   October  3,  1983 ]## 

/ 

The  Wallace  Alexander  Gerbode  Foundation 


Gerbode:   My  oldest  son,  Wallace  Alexander,  was  a  sophomore  at  Stanford  when 
he  was  killed  in  an  automobile  accident  near  Stanford.   This  was  a 
very  sad  and  shocking  event  in  our  lives.   In  thinking  about  it 
afterwards,  we  thought  that  we  might  establish  a  foundation  in  his 
name.   This  then  would  give  us  an  opportunity  to  do  things  in  the 
community  and  at  the  same  time  honor  him.   So  we  established  the 
foundation  on  that  basis.   The  foundation  was  made  to  benefit 
projects  in  the  Bay  Area  and  in  Hawaii.   So  ever  since  then  we've 
made  contributions  to  the  Nature  Conservancy,  civil  rights, 
minorities,  music  and  drama  organizations;  never  to  fellowships  or 
scholarships,  and  very  little  for  bricks  and  mortar.   The  idea  was 
to  start  programs  in  the  community  which  couldn't  be  started  or  funded 
initially  from  civic  funds,  to  get  them  going,  and  if  they  had 
survival  strength,  then  the  community  would  pick  them  up.   We've 
started  a  great  many  things  in  the  Bay  Area  and  in  Hawaii  which 
have  been  taken  up  by  the  communities  or  by  other  larger  agencies. 
I  could  furnish  you  with  a  long  list  of  them,  but  you  could  get 
them  from  the  [foundation]  office  if  you'd  like. 

We  made  a  modest  contribution  to  the  foundation  to  start  it, 
and  since  then  we've  added  money  to  it  and  invested  the  money,  so 
that  what  was  rather  modest  in  the  beginning  now  has  become  a  fairly 
important  foundation  in  San  Francisco. 


270 


Hughes:   When  you  say  "we,"  you  mean  your  wife  and  you. 

Gerbode:  Yes,  and  various  members  of  the  family.  Actually  my  wife  and  I 
made  the  major  contributions  to  it.   The  children  haven't  really 
made  contributions  to  it  to  any  large  extent.   We  have  a  foundation 
board,  upon  which  one  of  my  sons  and  one  of  my  daughters  sit,  and 
we  discuss  requests  for  funds  on  a  quarterly  basis. 

We  have  an  office  which  is  run  by  a  full-time  administrator 
[Thomas  C.  Lay ton]  and  a  secretary.  Whenever  you  start  giving  away 
money,  of  course,  you  have  numerous  requests  for  the  money,  and  so 
this  requires  someone  to  sort  these  things  out.   Many  of  the  requests 
are  not  in  our  field  of  interest,  and  therefore  they're  disqualified 
on  that  basis. 

Hughes:   In  reading  the  1982  annual  report,  the  list  of  interests  of  the 

foundation  fell  into  the  categories  of  art,  education,  environment, 
and  urban  affairs. 

Gerbode:  Yes,  that's  pretty  much  it. 
Hughes:   Why  those  fields  particularly? 

Gerbode:   Because  those  were  the  things  that  we  were  interested  in  as  citizens 
in  the  community.   I  suppose  it's  just  an  extension  of  what  we  were 
interested  in.   Having  the  foundation  gave  us  an  opportunity  to  do 
it  on  a  different  level. 

Hughes:   I  recognized  all  of  the  names  on  the  board  of  directors  [Frank  L.A. 
Gerbode,  Frank  Albert  Gerbode,  Maryanna  Gerbode  Shaw] ,  except  for 
Charles  [M.]  Stockholm. 

Gerbode:   Charles  Stockholm  is  a  vice  president  of  Crocker  Bank,  an  old  friend. 
I've  known  him  ever  since  he  was  a  small  boy.   His  father  built  our 
house  on  Divisadero  Street.   His  father  was  a  very  successful 
contractor,  and  his  grandfather  was,  too.   In  fact,  his  grandfather 
built  many  of  the  houses  in  Pacific  Heights. 

Hughes:   And  you  asked  him  to  join  the  board  because  of  his — 

Gerbode:  Well,  because  he's  a  businessman  and  a  banker.  There  is  money 

involved  and  businesses  involved,  so  he  can  get  a  lot  of  information 
for  us  through  his  bank  that  we  couldn't  get  as  individuals. 

Hughes:   Can  you  give  me  an  idea  of  what  the  review  procedure  is  for  an 
application? 


271 


Gerbode:   The  applications  are  sent  to  the  office,  and  they're  reviewed  by 

the  office  staff.   If  they  fall  in  our  sphere  of  interest,  then  they 
are  considered  at  a  board  meeting,  which  occurs  three  or  four 
times  a  year.   An  agenda  is  made  up;  all  the  materials  sent  in  to 
recommend  the  grant  are  included  in  the  agenda  but  are  reviewed 
by  the  board  well  in  advance  of  the  meeting. 

Hughes:    Is  it  the  responsibility  of  the  person  or  the  organization  applying 
to  supply  all  the  necessary  information? 

Gerbode:   Yes. 

Hughes:    Is  there  sufficient  information  in  the  application  itself  to  make 
a  decision? 

Gerbode:   If  there  isn't  enough  [information],  we'll  ask  for  it.   For  example, 
sometimes  they  don't  send  a  budget;  they  don't  say  how  they  want  to 
spend  their  money,  so  then  we  request  a  budget  and  a  description  of 
how  they're  going  to  spend  their  money.   The  grants  are  for  one 
year,  sometimes  two  or  three  years,  depending  on  what  is  involved  in 
the  program. 

We  also  occasionally  will  make  a  grant  which  is  actually  a  loan 
to  get  something  going.   People  can't  borrow  money  to  get  things 
started,  so  once  in  a  while  we'll  grant  an  agency  or  an  organization 
enough  money  to  get  them  going,  hoping  that  they  will  be  able  to 
generate  enough  finance  to  pay  us  back.   This  happens  once  in  a 
while.   Frequently  they  can't  repay  the  grant. 

Hughes:   Would  the  application  be  made  for  a  loan? 

Gerbode:   They  don't  call  it  a  loan,  but  they'll  say  they  hope  to  retain 

enough  earnings  to  repay  part  of  this  money  or  something  like  that. 
So  it  is  really  a  loan. 

Hughes:   How  do  you  make  the  choice  amongst  the  applications? 

Gerbode:   We  have  a  certain  amount  of  money  we  can  spend.   We  have  a  budget 
for  the  year.   We  look  over  every  application  critically,  both  as 
to  the  objective  of  the  application  and  the  budget  that  they've 
submitted.   Occasionally  we  will  give  them  what  they  request,  but 
more  often  we'll  say  that  we  can't  give  you  all  you  request;  we'll 
give  you  a  certain  amount.   If  we  gave  what  everybody  wanted,  there 
wouldn't  be  enough  money  to  go  around.   So  we'll  give  them  50  or  20 
percent  or  100  percent,  depending  on  the  merits  of  the  application. 


272 


Gerbode:   The  other  thing  that  happens  very  often  is  that  they  apply  to 

several  other  foundations  at  the  same  time,  and  if  they  are  all 
granted  what  is  requested,  then  they  have  more  money  than  they  need. 
So  it's  up  to  our  administration  to  find  out  from  other  foundations 
how  much  they  intend  to  give  to  a  particular  venture. 

Hughes:   Is  there  considerable  cooperation  among  foundations? 

Gerbode:  Yes.  The  foundation  directors  know  each  other  very  well,  and 
they're  very  knowledgeable  about  things  in  the  community  that 
require  private  funding,  and  they  discuss  [them].   We  encourage 
this.   [The  foundation  directors]  belong  to  several  organizations 
where  they  meet  and  discuss  voluntary  efforts  like  this. 

In  the  Hawaiian  Islands  we've  played  a  different  role  occasionally, 
because  the  Hawaiian  agencies  are  not  as  aggressive  in  looking  up 
things  to  do  with  their  money.   In  the  past  they  were  apt  to  give  the 
money  according  to  their  legal  requirements.   In  other  words,  you're 
supposed  to  give  5  percent  annually  of  the  value  of  your  portfolio 
or  your  assets,  and  very  often  they  [would]  pick  out  the  ordinary 
things,  like  Boy  Scouts  and  time-honored  things,  just  to  satisfy 
the  requirements.  We've  tried  in  the  Islands  to  pick  out  [organizations] 
which  require  help,  and  by  giving  [them]  money,  we've  encouraged  the 
Hawaiian  foundations  to  help,  too,  and  they've  done  it.   This  is 
true  not  only  on  Oahu,  but  it's  true  on  Maul  and  Kauai,   Somebody  on 
the  outside  has  to  make  a  little  contribution  to  cause  attention 
and  popularity. 

Hughes:   Do  you  remember  what  some  of  the  first  awards  were  in  the  early 
days? 

Gerbode:   I  think  probably  some  of  the  first  awards  were  Planned  Parenthood 

and  things  like  the  Nature  Conservancy.  We  were  very  active  in  the 
various  agencies  that  are  trying  to  stop  development  of  areas  that 
might  be  better  [used  by]  the  public  at  large. 

Hughes:   In  San  Francisco  specifically? 

Gerbode:  Well,  Marin  County.   For  example  there's  a  big  valley  over  there 

which  was  going  to  be  developed  into  a  whole  bunch  of  condominiums 
by  an  oil  company.   The  Nature  Conservancy  and  the  people  of  Marin 
County  were  against  this.   They  wanted  it  to  be  a  public  park.   So 
the  Nature  Conservancy  got  together  a  number  of  people  and  what 
happened  was  that  we  bought  this  piece  of  land  from  the  oil  company 
at  the  same  price  they  had  paid  for  it  and  then  gave  it  to  [the] 
Nature  Conservancy ,  who  then  gave  it  to  the  government .   It ' s  now 
a  public  park. 


273 


Hughes:   This  is  the  piece  at  the  Marin  headlands,  called  the  Gerbode 
Preserve? 

Gerbode:   Yes. 

Hughes:   The  Nature  Conservancy  seems  to  be  a  particular  love  of  yours,  at 
least  if  dollars  speak — 

Gerbode:   It  goes  way  back  to  when  they  first  began  to  do  this  sort  of  thing. 
We  were  among  the  first  to  get  interested  in  the  techniques  of 
converting  private  land  to  public  use  on  a  fair  and  equitable 
basis.   The  people  working  in  this  area  are  very  fine  people.   They 
have  the  best  interests  of  the  public  at  large  at  heart,  and  I  think 
they've  done  a  very  good  job. 

Hughes:   Would  you  say  that  the  foundation  has  changed  emphasis  since  it  was 
founded? 

Gerbode:   It's  broadened  its  field  quite  a  good  deal.   We've  gotten  into 
supporting  various  activities  at  Stanford  and  the  University  of 
California.   For  example,  in  the  law  school  at  Stanford  there  are 
several  projects  which  couldn't  be  funded  out  of  university  funds, 
but  could  be  funded  privately,  and  we've  helped  them  do  that.   Those 
are  projects  which  involve  activities  in  the  community  by  students 
or  professors. 

Hughes:    Is  this  broadening  the  result  of  having  more  money  to  spend,  or 
is  it  a  change  in  philosophy? 

Gerbode:   No.   Usually  what  happens  is  that  an  organization  like  this  is  in 
everybody's  focus,  so  everybody  that  wants  money  for  any  project 
will  try  to  get  it  from  a  foundation.   And  some  of  the  things  that 
are  requested  are  really  worth  supporting.   That's  how  it  comes 
about . 

Hughes:    So  the  change  in  emphasis  really  is  external — the  fact  that  you  have 
a  broader  range  of  applications  rather  than  being  due  to  an 
intrinsic  change  in  the  board  itself. 

Gerbode:   Yes.   There  are  more  applications  all  the  time.   Particularly  now 
since  so  many  government  projects  have  been  cut  back  and  there's 
less  money  available  for  new  projects  on  a  city,  state,  or  federal 
level,  so  that  there  is  much  more  demand  on  private  foundations. 

Hughes:   Mr.  Layton  made  what  I  thought  was  a  very  interesting  comment.   He 

said  something  to  the  effect  that  he  believed  the  foundation  was  more 
liberal  in  outlook  than  the  board  of  directors  itself. 


274 


Gerbode:  You  mean  to  say  that  what  he's  trying  to  do  is  more  liberal  than 
what — 

Hughes:   No,  he  wasn't  referring  to  himself.   He  was  trying  to  say  that  the 
foundation  itself  takes  on  a  character  that  is  somewhat  independent 
of  each  individual  member  of  the  board  of  directors,  that  there  is 
a  foundation  identity  which  is  above  and  beyond  that  of  the 
individuals  making  up  the  board. 

Gerbode:   That  may  be  true.   It  may  be  wishful  thinking  on  his  part,  too. 

Actually ,  every  grant  is  discussed  at  some  length  by  all  the  board 
and  voted  on. 

Hughes:   I  can  see  that  you  would  perhaps  be  induced  to  move  in  certain 
directions  by  the  very  nature  of  the  types  of  grants  that 
organizations  request. 

Gerbode:   Oh,  there's  no  question  that  applications  make  things  visible  that 
we  wouldn't  otherwise  see.   We  obviously  can't  be  aware  of  every 
organization  that  is  starting  something.   For  example,  I  never  heard 
of  the  Pickle  Family  Circus  before  they  put  in  an  application. 
When  we  got  the  application  and  began  to  look  into  it,  it  turned 
out  to  be  quite  a  good  thing  to  support.   We  probably  were  largely 
responsible  for  getting  it  started.   I  don't  know  whether  that 
could  be  considered  a  liberal  thing,  but  we  certainly  made  it  more 
visible. 

Hughes:   I  would  think  that  the  coloration  would  become  most  obvious  in  the 
category  of  urban  affairs. 

Gerbode:  Well,  there  are  several  instances  where  the  people  on  Kauai  wanted 

to  do  something  or  stop  something,  but  they  couldn't  do  it  very  well 
because  they  were  not  very  knowledgeable  about  how  to  go  about  it. 
For  example,  right  now  there's  a  very  embarrassing  situation  for  a 
group  of  developers  who  decided  that  they  could  put  up  a  hotel  and 
a  large  collection  of  condominiums  on  a  certain  acreage  near  Lihue 
without  getting  all  the  proper  permits.   They  thought  because  they 
had  so  much  money  and  had  bought  the  land  that  they  could  just  go 
ahead  and  do  it.   Well,  the  people  didn't  like  this  on  Kauai.   So 
they  formed  a  citizens'  group  to  object  to  it,  and  it  was  actually 
brought  to  the  courts.   One  court  ruled  that  their  development  was 
legitimate,  and  another  court  ruled  that  it  was  not  legitimate. 
The  citizens  were  doing  this  without  very  much  legal  help,  so  we 
gave  them  enough  money  so  that  they  could  at  least  discuss  it  on  a 
proper  intellectual  and  legal  basis.   We're  not  trying  to  influence 
their  decision — 


275 


Hughes:   No,  but  to  give  them  the  tools. 

Gerbode:   Give  them  the  tools  to  make  an  intelligent  decision.   So  actually 
this  whole  project  is  stopped.   There's  a  half -built  hotel  and 
some  condominiums  that  were  finished  and  sold  and  some  people 
living  in  them;  quite  a  few  others  are  half-built.   It's  a  mess. 
But  the  fact  remains  that  they  should  not  have  gone  ahead  without 
getting  the  proper  building  permits  and  permission.   They  thought 
it  was  such  a  sleepy  little  island  they  could  get  away  without  going 
through  all  the  formalities.   Well,  the  people  finally  woke  up. 

We  try  not  to  get  involved  in  politics,  because  that's  a  very 
difficult  thing.   But  some  of  the  things  border  on  politics,  because 
a  lot  of  things  that  happen  in  a  community  are  based  on  political 
activity. 

Hughes:   Would  the  politics  of  an  issue  keep  you  away  from  it? 

Gerbode:   Not  necessarily.   I  think  the  issue  itself  is  what  we  would  consider. 
Whether  it  was  involved  with  politics  would  be  of  secondary 
consideration.   But  sometimes  organizations  ask  for  money  when  we 
feel  they  could  do  it  themselves.   For  example,  the  legal  profession 
in  the  Bay  Area  has  occasionally  asked  for  substantial  funds  to 
start  things  like  a  legal  aid  society  or  pay  for  lawyers  to  defend 
people  who  don't  have  money.   We've  helped  some  of  these  things, 
but  actually  it's  my  belief  that  the  lawyers  don't  give  enough 
money  to  charitable  events.   They're  very  parsimonious  when  it  comes 
to  contributions.   It  seems  to  me  that  they  ought  to  be  doing  more 
of  it:  themselves,  rather  than  going  out  for  other  organizations. 
I  don't  know  of  any  doctors  that  have  gone  around  passing  the  hat 
for  various  things  they  do  like  that. 

Hughes:   Once  you  award  a  grant,  how  much  leeway  does  the  organization 
receiving  the  grant  have  in  the  way  the  money  is  spent? 

Gerbode:   They're  supposed  to  follow  the  outline  which  they've  submitted  for 
the  grant.   I  think  that  our  executive  director  would  watch  these 
developments,  and  if  they  are  obviously  doing  something  entirely 
different,  he'd  say  something  about  it. 

Hughes:    How  does  he  watch? 

Gerbode:   We  call  up  and  drop  in  on  them  once  in  a  while.   Not  like  a  big 
brother  looking  over  their  shoulder,  but  more  because  we're 
interested  in  what  their  project  is  supposed  to  be  doing. 

Hughes:    It's  an  informal  follow-up? 


276 


Gerbode:   It's  an  informal  follow-up. 
Hughes:   Do  you  ever  solicit  applications? 

Gerbode:   I  wouldn't  say  that  we  never  solicit  applications.  Occasionally  we 
will  see  something  that  needs  a  little  boost  and  we'll  suggest 
that  we  might  review  an  application.   That's  been  done  particularly 
in  the  Hawaiian  Islands,  not  so  much  locally  in  San  Francisco. 

Hughes:   I  know  there  are  geographical  limits  to  the  foundation. 

Gerbode:  We're  constantly  being  asked  to  give  money  for  national  things. 

For  example,  we've  had  quite  a  few  requests  on  a  national  level  for 
money  to  legalize  abortions,  but  we  try  to  avoid  getting  involved 
in  national  things,  because  there  are  too  many  of  them  and  it's 
very  hard  to  monitor  them.   If  we  ship  money  off  to  New  York,  we 
would  never  see  it  again.   We  can  do  a  much  better  job  by  supporting 
things  in  the  Bay  Area  and  in  Hawaii,  because  we  are  familiar  with 
the  cities  and  what  else  is  going  on. 

Hughes:   Does  the  fact  that  you  were  asked  on  a  national  level  to  support 
abortion  mean  that  the  foundation  has  quite  a  name  for  its  work 
with  Planned  Parenthood? 

Gerbode:   They  know  that  we  have  supported  Planned  Parenthood  from  the  very 

beginning.   Mrs.  Gerbode  was  on  the  first  board  of  Planned  Parenthood 
in  San  Francisco,  when  they  had  a  little  place  out  in  the  Sunset 
District  and  it  was  very  unpopular  to  even  be  associated  with  such 
a  "bad"  thing.   But  we've  always  been  in  favor  of  the  right  of 
women  to  have  a  child  or  not  to  have  a  child. 

Hughes:   Was  that  when  the  foundation  was  first  founded? 

Gerbode:  Oh,  even  before  the  foundation  we  made  contributions  to  Planned 
Parenthood.  Obviously  we're  not  a  Catholic  family.  But  I  know 
some  Catholics  who  are  very  much  in  favor  of  Planned  Parenthood. 

Hughes:   They're  the  sensible  ones. 

Gerbode:   I  think  they'll  probably  go  to  heaven  anyway!   Maybe  even  quicker! 

Hughes:   Can  you  give  me  a  rough  estimate  of  how  many  applications  you 
receive  in  a  year? 

Gerbode:  You'd  better  ask  Tom  Lay ton.   Every  meeting  we  have,  which  is 

quarterly,  we'll  review  perhaps  twenty  new  applications,  but  we  will 
also  have  turned  down  twenty  or  thirty  automatically. 


277 


Hughes:   The  rejection  is  simply  on  the  basis  of  the  interests  of  the 
foundation? 

Gerbode:   No,  rejection  is  sometimes  based  on  the  fact  that  we  know  another 
agency  is  going  to  take  care  of  them. 

Hughes:    I  didn't  phrase  that  question  very  well.   I  was  meaning,  before 
the  application  even  gets  to  the  board  of  directors,  the  staff 
would  reject  some  applications? 

Gerbode:   Oh  yes.   We  reject  perhaps  twenty  three  or  four  times  a  year;  maybe 
fifty  or  sixty  are  rejected  by  the  staff.  We  always  have  a  list 
of  the  rejections  that  are  made  by  the  staff,  and  occasionally 
we'll  ask  for  a  review  of  one  of  those  rejected  applications,  if 
we  think  that  maybe  it  should  be  given  further  consideration  by  the 
board.   It  doesn't  happen  very  often. 

Hughes:   Do  you  ever  require  an  organization  to  match  funds? 
Gerbode:   Yes,  that's  quite  common. 
Hughes:   Have  you  always  done  that? 

Gerbode:   It  happens  automatically.   When  the  people  submit  an  application, 
they  say,  we  have  ten  thousand  dollars;  we  need  twenty.   That's 
matching  funds. 

Hughes:    I  know  Tom  Layton  is  director,  and  I  spoke  to  a  woman  assistant. 
Is  there  anybody  else  on  the  staff? 

Gerbode:  No,  that's  all.  We  have  people  come  in  and  do  clerical  work 

occasionally.   But  [the  foundation]  is  really  run  by  Tom  Layton  and 
the  secretary. 

Hughes:    In  1969  Congress  passed  the  Tax  Reform  Act,  which  established 

tighter  regulations  on  all  nonprofit  organizations.   Did  that  cause 
any  particular  change? 

Gerbode:   Not  really.   The  only  thing  it  affected  is  the  Island  properties 

we  have  at  Diamond  Head.   Before  that  1969  tax  law  was  put  through 
we  could  occasionally  go  down  and  use  those  houses  ourselves,  but 
that  law  pretty  much  forbids  personal  use  by  the  board  of  any 
foundation  property.   We  can  go  down  there  for  the  purposes  of 
looking  over  the  property  but  we  can't  go  there  and  entertain. 

Hughes:   Tell  me  a  bit  more  about  that  property. 


278 


Gerbode:  There  are  two  houses  on  the  Diamond  Head  property.   The  first 

house  was  built  by  my  mother-  and  father-in-law,  Mary  and  Wallace 
Alexander.   He  was  president  of  Alexander  and  Baldwin.   They  spent 
about  half  the  time  there  and  half  in  Piedmont.*  They  bought  the 
land  from  Jay  Gould  of  New  York,  a  rather  famous  man,  and  they 
built  a  house  which  was  designed  by  a  cousin,  Will  Dickey.   He's 
the  architect  who  designed  the  Claremont  Hotel.   The  Claremont 
Hotel  in  Berkeley  is  an  entirely  different  structure.   He  is 
credited  in  the  Hawaiian  Islands  with  incorporating  Oriental  style 
in  the  construction  of  the  roofs  and  the  general  appearance  of  the 
houses  and  buildings.   So  they  are  rather  unique.   They're  well  known. 
They've  been  illustrated  quite  often  in  various  architectural 
magazines.   The  house  was  built  out  of  coral  and  lava  rock,  so  the 
walls  are  very  nice  looking  and  obviously  very  permanent. 

There  was  some  adjoining  property  owned  by  a  man  by  the  name 
of  Mr.  Atherton  Richards,  and  my  mother-  and  father-in-law  bought 
the  land  from  him  a  few  years  after  my  wife  and  I  were  married. 
Then  we  built  a  house  which  complemented  the  one  that  they  had  on 
this  other  piece  of  property  right  next  door.  Now  the  lawns  and 
the  acreage  and  everything  are  contiguous. 

If 

Gerbode:  We  rented  our  house  a  good  deal  of  the  time,  because  obviously  we 

couldn't  use  it  fully.   I  was  busy  being  a  doctor,* or  being  trained 
to  be  a  doctor.   One  of  the  renters  left  a  cigarette  burning  in  the 
bedroom  while  he  was  looking  over  his  income  tax  papers.   He  had 
failed  to  submit  income  tax  returns  for  a  couple  of  years ,  although 
he  was  a  wealthy  man.   I  think  he  was  trying  to  sort  out  the  papers 
so  that  he'd  have  answers  for  the  IRS,  and  he  either  left  a  cigarette 
near  them  or  something  like  that  happened.   So  the  house  virtually 
burned  down.   But  we  had  it  fully  insured,  so  we  rebuilt  it  pretty 
much  the  way  it  was  before. 

Hughes:   When  was  this? 

Gerbode:   Middle  or  late  sixties.  When  my  mother-  and  father-in-law  and 

Mrs.  Gerbode  died,  we  put  both  houses  into  our  family  foundation. 
Since  then  we've  rented  the  houses  through  the  family  foundation. 

Hughes:   The  grants  by  the  foundation  for  1982  range  from  under  a  thousand 
dollars  to  the  one  hundred  thousand  dollars  that  was  awarded  to 
the  Nature  Conservancy.   Would  you  say  that  this  is  a  fairly  typical 
range? 


*The  preceding  two  sentences  were  moved  from  the  session  on  7/20/83. 


279 


Gerbode: 


Hughes: 


Gerbode: 


Hughes : 
Gerbode: 
Hughes: 
Gerbode: 

Hughes: 
Gerbode: 

Hughes: 
Gerbode: 


I'd  say  the  average  grant  is  from  one  to  thirty  thousand  dollars. 
There  aren't  very  many  one  thousand  dollar  grants,  though. 

Obviously  the  foundation's  policy  is  to  fund  a  number  of  organizations 
in  a  modest  way  rather  than  to  give  large  sums  to  a  very  few 
organizations. 

I  think  that's  true.   Our  general  policy  is  to  get  things  started, 
as  I  mentioned  to  you  before,  which  we  think  would  have  enough 
value  to  be  carried  by  the  community,  by  other  organizations.   Pickle 
Family  Circus,  for  example,  carries  itself  now.   There  are  several 
dance  groups,  too,  that  we  started — they  are  mostly  connected  with 
various  countries — and  they  are  on  their  own  now,  too.   There's  a 
Holocaust  memorial  being  developed  now  [by  the  Palace  of  the  Legion 
of  Honor]  to  remind  people  of  the  number  of  Jews  that  were  killed 
during  the  war.   We've  supported  that  because  we  think  it's  a  good 
thing  to  have  people  see  what  it  was  all  about.  Many  people  don't 
think  any  Jews  were  killed  at  all,  or  there  weren't  any  concentration 
camps.   A  lot  of  Germans  think  that,  too. 

You  certainly  know  better  than  that. 

Yes. 

What  would  you  say  is  the  image  of  the  Gerbode  Foundation? 

I  think  probably  the  image  is  one  of  an  organization  that  is 
interested  in  community  affairs  in  the  Bay  Area. 

There  wouldn't  be  a  political  coloration?   I'm  thinking  on  the 
scale  of  conservative  to  liberal. 

I  think  we're  right  in  the  middle  somewhere.   For  example,  we 
supported  the  building  of  the  [Louise  M.  Davies]  symphony  hall. 
You  might  consider  that  conservative,  yet  it  takes  care  of  a  lot  of 
liberal  people,  too. 


Well,  things  have  changed, 
nature-related  activities. 


In  the  old  days  it  was  unusual  to  fund 


That's  true.   I  think  that  people  are  generally  more  conscious  of 
preserving  green  areas.   We'd  been  very  interested  in  this  in 
San  Francisco  long  before  the  foundation  was  founded,  in  being  sure 
that  where  there  was  a  possibility  of  making  a  park,  that  we  could 
help  get  the  park  made.   This  is  a  form  of  nature  conservancy, 
preserving  green  areas  in  the  community. 


280 


Hughes:   In  the  annual  report,  religious  activities  are  specified  as  an 
area  which  are  not  funded.  Was  this  a  conscious  exclusion? 

Gerbode:   I  don't  know  how  to  answer  that  question.   We  have  not  been  very 

interested  in  religious  activities  in  the  community.   I  don't  know 
whether  that  was  conscious  or  unconscious. 

Hughes:   So  it's  just  a  lack  of  interest,  not  fear  of  being  accused  of 
supporting  one  religion  against  the  other. 


Religion 


Gerbode:  Not  really.   [My  wife's]  family,  way  back  in  New  England,  were 
Congregationalists.   It's  a  very  simple  form  of  a  Protestant 
religion.   Their  churches  and  their  programs  are  simple.   The 
Hawaiian  mission  children's  church,  the  Kuaihau  Church,  was  built 
by  missionaries,  and  their  programs  are  very  simple  and  very  humane. 
That's  the  sort  of  religion,  I  think,  that  they  practiced.  My 
mother-  and  father-in-law  went  every  Sunday  in  Piedmont  to  a  very 
small  Protestant  church,  and  they  supported  that  church's  activities. 
My  wife  and  I  would  go  occasionally,  but  not  very  much. 

Hughes:   And  that  was  a  Congregationalism  church? 

Gerbode:   I  guess  they  called  it  a  joint  Protestant  church,  encompassing 
various  Protestant  religions. 

Hughes:   What  about  your  side  of  the  family? 

Gerbode:   My  father  was  a  Catholic,  but  my  mother  wasn't  and  I  wasn't  either. 
When  I  took  a  look  at  the  Catholic  religion,  I  decided  I  couldn't 
really  be  a  Catholic  without  being  dishonest. 

Hughes:   What  were  the  grounds — ? 

Gerbode:   Well,  if  you  follow  the  rules  of  being  a  Catholic,  the  rules  are 
so  strict  that  I'd  be  going  to  confession  twice  a  week. 

Hughes:    Or  maybe  more  often. 

Gerbode:  Or  maybe  more  often.   I  don't  really  believe  that  when  St.  Peter 

said,  "Upon  this  rock  I  founded  my  church,"  he  meant  only  the  Catholic 
church.   That's  the  basis  for  the  Catholic  church  saying  that  there's 
only  one  church.   But  I  have  a  lot  of  doubts  about  various  forms  of 
religion  anyway. 


281 


Hughes:  Was  this  a  disappointment  to  your  father  when  you  didn't  follow — ? 

Gerbode:  No,  he  didn't  care. 

Hughes:  He  wasn't  a  strong  Catholic  influence? 

Gerbode:  No. 

Hughes:  Does  that  date  back  to  the  German  background? 

Gerbode:   Saxon.   I  think  his  family  were  quite  strong  Catholics,  and  they 
wanted  him  to  be  a  priest. 

Hughes:   That  would  be  interesting  in  a  mining  town. 

Gerbode:   But  if  he  had  been  a  priest,  then  I  wouldn't  be  here! 

Martha  Alexander  Gerbode 


Hughes:  Shall  we  talk  about  your  wife?  I  know  that  she  was  active  in  the 
foundation,  but  I  would  really  like  to  go  further  back  and  hear  a 
little  bit  about  her  upbringing. 

Gerbode:   She  was  an  only  child.  She  was  the  daughter  of  Wallace  and  Mary 

Alexander.   She  was  born  in  Piedmont  and  raised  there.   She  went  to 
private  school  there,  and  then  subsequently  went  to  Mt.  Vernon 
Seminary  in  Washington,  which  was  sort  of  like  a  junior  college  for 
girls.   Then  she  went  to  Stanford  after  that  and  graduated  from 
Stanford.* 

I  think  that  you  could  characterize  my  wife  as  being  a  liberal. 
She  was  more  liberal  than  conservative.   Although  she  was  a  Republican, 
she  very  frequently  voted  for  candidates  who  weren't  Republicans. 
She  had  always  been  interested  in  the  underdog.   She  was  very  apt 
to  take  an  unpopular  stance  if  she  felt  that  it  was  justified. 

Hughes:   Did  her  family  background  warrant  this  orientation? 

Gerbode:   Her  mother  and  father  were  very  conservative  people.   On  the  other 
hand,  they  did  support  community  [activities]  on  a  broad  basis. 

Hughes:    Even  liberal  community  activities? 


*This  paragraph  was  moved  from  the  interview  on  7/20/83. 


282 


Gerbode:   Once  in  a  while,  but  not  so  much.   She  was  much  more  liberal  than 
they.   She  would  periodically  rise  up  and  do  something  unusual. 
For  example,  when  Lamar  Hunt  was  talking  about  taking  over  Alcatraz 
and  making  it  into  a  gambling  resort,  she  took  a  very  strong  stand 
against  it  and  publicly  denounced  the  whole  idea,  and  even  told 
the  mayor  that  she'd  be  willing  to  raise  money  to  buy  it  for 
San  Francisco.   The  mayor  thought  this  was  quite  funny  in  a  way. 
He  said,  "Well,  I  wouldn't  mind  if  she  bought  it.   If  she  wants  to 
buy  it,  that's  fine  with  me."  Something  like  that.   But  actually 
the  community  did  react  against  Hunt's  offer. 

Hughes:   What  were  her  grounds  for  disapproval? 

Gerbode:   She  thought  it'd  be  much  better  as  a  national  park,  which  is  what 

it  turned  out  to  be.   I  think  people  go  over  there  by  the  thousands 
to  look  at  the  jails  and  see  how  we  took  care  of  the  criminals  and 
where  Al  Capone  was  interred.   That's  been  a  jail,  you  know,  long 
before  modern  times.   It  was  a  jail  in  the  1800s. 

Hughes:   Under  the  Spanish. 
Gerbode:   Yes. 

She  also  took  up  Planned  Parenthood,  as  I  mentioned  to  you 
before,  when  it  was  unpopular,  and  actually  was  under  the  rug. 
Anyone  who  discussed  Planned  Parenthood  was  considered  to  be  a  bit 
wild. 

Hughes:   How  did  she  come  to  be  that  way? 

Gerbode:   [laughs]   I  don't  know.   I  suppose  maybe  she  was  compensating  for 
the  fact  that  she  was  financially  secure,  maybe  a  little  conscious 
of  this  and  not  wanting  to  show  it  too  much. 

Hughes:   Do  you  think  Stanford  had  any  influence? 

Gerbode:   I  don't  really  think  so.   She  was  a  good  student  at  Stanford,  but 
she  didn't  join  any  liberal  causes  down  there. 

Hughes:   When  did  her  real  community  involvement  start? 

Gerbode:   I  guess  [after]  we  were  married  and  began  to  live  in  San  Francisco. 
Then  she  began  to  look  around  and  find  things  to  do  as  a  wife  and 
as  a  citizen,  and  she  found  that  many  of  the  so-called  liberal 
causes  were  more  interesting  than  just  giving  money  to  the  Boy  Scouts 
and  the  YMCA. 


Martha  Alexander  Gerbode 


283 


Hughes:   You  said  that  her  parents  had  given  money  to  community  efforts  in 
the  past;  did  that  make  it  almost  certain  that  she  would  become 
involved  with  charity  work? 

Gerbode:   I  don't  know.   I  think  probably  it  certainly  put  the  basis  of 
giving  into  her  behavior. 

Hughes:    I  don't  know  enough  about  the  founding  families  of  Hawaii*  to  know 
whether  philanthropy  is — 

Gerbode:   Philanthropy  has  always  been  a  characteristic  of  then.  But  I  think 
in  the  last  twenty  or  thirty  years,  philanthropy  has  in  general 
been  much  more  inclined  to  give  to  the  museums,  cultural  [activities] 
like  that ,  and  to  some  of  the  schools ,  rather  than  to  reach  out  and 
get  programs  going.   That's  where  we've  tried  to  do  a  little 
stimulating. 

Hughes:    I  know  there  are  a  tremendous  number  of  foundations  in  San  Francisco; 
do  you  think  it  could  be  characterized  as  a  city  that  is  very  strongly 
supported  by  private  foundations? 

Gerbode:   There  are  some  very  wealthy  families  in  San  Francisco  that  have 

always  been  interested  in  philanthropy.   The  Jewish  families,  the 
Haas  and  the  Stern  families ,  have  always  been  very  active  in 
philanthropy.   I  use  those  two  names,  but  there  arc  many  branches 
of  the  family  which  have  been  very  interested  in  good  deeds  in  the 
community  for  a  long,  long  time. 

Hughes:    So  you  think  that  set  the  ball  rolling,  so  to  speak. 

Gerbode:   It's  helped  enormously  to  do  that.   I'm  sure  that  the  same  thing  is 
true  in  other  big  cities.   In  Los  Angeles,  for  example,  there  are 
a  group  of  people  who  have  been  in  family  foundations  for  a  long 
time  and  have  done  a  lot  of  good — the  Chandler  family,  for  example, 
the  publishing  family  in  Los  Angeles ,  has  done  a  tremendous  amount 
of  good  in  the  community  through  its  foundations  and  personal 
giving. 

Hughes:   Can  you  tell  me  a  little  more  about  your  wife's  day-to-day 
activities? 

Gerbode:   She  was  on  quite  a  few  boards  in  the  community.   She  was  on  the 

board  of  Planned  Parenthood,  [the]  YWCA,  and  several  other  organiza 
tions.   She  was  very  interested  in  the  original  San  Francisco 


*The  Alexanders  are  one  of  the  white  missionary  families  who  came 
to  the  Hawaiian  Islands  to  convert  the  natives  to  Christianity. 


284 


Gerbode:   Planning  and  Urban  Redevelopment  Board,  which  had  to  do  with 

planning  in  the  community  as  a  whole.   I  think  she  was  on  the  board 
of  Nature  Conservancy.   So  she  spent  a  lot  of  time  in  meetings 
with  these  organizations.   Obviously  if  she  was  going  to  a  meeting, 
she  would  have  an  influence  on  the  decision  making.   She  enjoyed 
doing  that  very  much. 

Hughes:   Over  the  years  I  would  think  she  would  have  come  to  be  known  as  an 
expert  in  certain  areas. 

Gerbode:   I  don't  know  about  being  an  expert.   I  think  she  was  certainly  known 
for  her  stance  in  all  these  organizations. 

Hughes:   Because  of  this  reputation,  were  there  many  demands  for  her 
participation? 

Gerbode:  Oh  yes.   Demands  for  money,  too. 

It's  curious,  in  all  these  years  we  never  got  much  involved 
with  any  religious  activity  in  the  community.   You'd  think  that 
churches  would  be  after  us  a  good  deal.   Well,  there  was  one  church 
in  our  neighborhood,  an  Episcopal  church.   We  thought  it  would  be 
nice  to  join  the  church  and  get  involved  with  some  of  their  programs. 
So  we  went  to  church  a  few  Sundays,  and  began  to  get  interested, 
and  the  next  thing  we  knew,  we  were  approached  to  give  a  vast  sum 
of  money  to  the  church  to  rebuild  it  and  to  do  a  lot  of  other  things. 
So  we  told  them  that  isn't  why  we  were  there.  We  were  there  because 
we  felt  a  little  religion  might  do  us  good.   But  we  didn't  want  to 
get  the  religion  by  giving  them  a  lot  of  money. 

Hughes:   Did  they  lay  off? 

Gerbode:  They  laid  off,  and  then  they  weren't  interested  in  us  after  that. 

Hughes:   I  understand  that  your  wife  was  a  major  force  in  saving  Diamond  Head. 
Was  that  beyond  the  purview  of  the  foundation? 

Gerbode:  Yes.   This  was  entirely  on  the  basis  of  being  a  citizen.   We  had 
the  Diamond  Head  properties.   There  was  a  Chinese  businessman  who 
had  made  pots  of  money  during  the  war,  and  he  wanted  to  buy  up  the 
property  along  Diamond  Head  toward  Kahala  and  build  a  lot  of  high- 
rise  buildings  and  condominiums.   Financially  it  would  have  been 
tremendous  for  him  if  he  had  gotten  away  with  it,  and  there  were 
certain  people  in  the  community  who  were  in  favor  of  it.   The 
argument  always  is,  well,  if  you  put  these  things  up,  you'll  get 
that  much  more  back  in  taxes. 


285 


Gerbode:   But  [Martha]  and  another  elderly  woman  by  the  name  of  Mrs.  [Alice 
Spaulding]  Bowen,  who  lived  on  Diamond  Head  Road,  or  nearby, 
fought  this  thing  out.   One  thing  that  Martha  did  was  to  buy  the 
Fagan  property,  which  is  a  big  piece  of  land  down  the  road,  rather 
than  let  the  Chinese  fellow  get  it.   This  was  like  playing  monopoly. 
If  you  get  certain  pieces  in  a  certain  area,  then  you  can  stop  a 
development.   By  buying  this  piece  of  property,  she  stopped  a  lot 
of  the  thought  of  converting  all  that  land  into  highrises  and 
condominiums.   [The  two  women]  organized  a  campaign  which  all  the 
other  people  who  had  property  along  Diamond  Head  got  interested  in. 
They  realized  that  their  views  were  going  to  be  cut  off  and  that 
their  neighborhood  would  change  entirely.   Even  the  transportation 
down  that  little  road  would  have  been  impossible  with  a  lot  of  big 
buildings.   It's  just  a  small,  two-way  road.   To  make  it  a  super 
highway  would  be  very,  very  difficult.   It  could  be  done,  but  not 
without  losing  an  awful  lot  of  good  land  to  do  it. 

Hughes:   We've  talked  about  your  wife  from  the  standpoint  of  her  community 
activities.   Can  you  give  me  a  better  idea  of  what  she  was  like  as 
an  individual? 

Gerbode:   She  was  a  very  compassionate  individual.  She  felt  very  strongly 

about  right  and  wrong,  and  she  would  take  strong  stands  on  issues. 
In  general,  she  was  suspicious  of  successful  business  people  and 
backers. 


Gerbode:   Some  of  the  people  she'd  gone  to  school  with  in  childhood  thought 
that  she  was  much  too  liberal.   So  socially  we  didn't  see  those 
people  very  often. 

Hughes:   Did  she  ever  run  into  other  problems  because  of  her  liberal  stands? 

Gerbode:   No,  I  don't  think  so.   I  think  in  the  community  she  was  not  very 
impressed  with  being  a  society  person,  and  in  our  home  we  never 
pursued  very  much  of  a  social  life  in  that  sense.   We  had  our  friends 
in  the  community  who  were  important  people,  but  were  not  essentially 
society  people. 

Hughes:    How  did  your  viewpoint  coincide  with  hers? 

Gerbode:   I  was  always  too  busy  in  my  profession  to  worry  too  much  about  it 
one  way  or  the  other.   When  you're  working  ten,  twelve,  fourteen 
hours  a  day  putting  something  together,  you're  not  very  concerned 
about  things  like  that. 


286 


Hughes:   I  was  thinking  more  in  the  political  sense  of  her  liberal  causes. 
Do  you  think  you  in  general  went  along  with  her  viewpoints? 

Gerbode:  Yes,  I  would  go  along  with  most  of  them,  but  sometimes  I  wouldn't 
go  along  with  them  at  all. 

Hughes:  And  you  said  so. 

Gerbode:  Sure. 

Hughes:  And  she  went  right  on. 

Gerbode:  Usually. 

Hughes:   We  will  at  a  later  date  have  Maryanna  speak  for  herself,*  but  I 
was  wondering  if  you  could  say  something  about  her  role  in  the 
foundation. 

Gerbode:   First  of  all,  she's  a  very  intelligent  young  woman,  and  she  is 
very  much  like  her  mother.   She  is  given  to  thinking  liberally 
about  things.   She  also  has  a  very  strong  will,  as  her  mother  did, 
too.   She's  been  very  interested  in  the  foundation,  in  its  activities, 
and  she  reviews  all  the  applications  very  carefully  and  writes  an 
independent  opinion  about  them. 

Hughes:   The  other  board  members  do  not  do  this? 

Gerbode:  Yes,  they  do  it.   They  all  review  the  programs.   But  I  think  she's 

perhaps  a  little  more  serious  about  it  than  the  rest  of  us.   She  has 
more  time  also  to  look  into  some  of  the  things  that  are  suggested. 

Hughes:   So  she  would  do  more  than  just  read  the  application. 

Gerbode:   She  might  even  go  take  a  look  or  call  up  somebody  or  have  Tom 

Layton  do  it.  She'll  say,  "Tom,  why  don't  you  investigate  this  part 
of  it.   I'd  like  to  know  a  little  bit  more  about  it." 

Hughes:   Do  you  think  that  her  opinion  influences  your  eventual  decision? 
Gerbode:   If  her  reasons  are  valid,  then  she  influences  me. 

Hughes:   I'm  glad  you  listen  to  a  woman.   [laughter]   I  understand,  again  from 
talking  to  Tom  Layton,  that  he  and  Maryanna  spend  quite  a  bit  of 
time  together  working  on  foundation  business. 


*The  transcript  of  an  interview  recorded  on  November  4,  1983  with 
Maryanna  Gerbode  Shaw  is  on  deposit  in  The  Bancroft  Library. 


Gerbode; 


Hughes: 
Gerbode: 
Hughes : 

Gerbode: 


Hughes: 
Gerbode : 

Hughes : 

Gerbode: 

Hughes: 

Gerbode: 

Hughes: 

Gerbode: 


287 


He's  very  apt  to  call  her  more  often  than  me.   He'll  call  me  about 
certain  aspects  of  foundation  activities,  but  on  certain  decision- 
making  things,  he'll  call  her  and  get  an  opinion.   We  actually 
have  kind  of  a  working  rule  that  he  and  one  other  foundation  board 
member  can  make  an  independent  decision  before  a  board  meeting  for 


grants  of  a  small  amount  of  money, 
apt  to  call  her  than  to  call  me. 


On  those  small  ones  he's  more 


Did  she  work  very  closely  with  your  wife? 

No. 

Do  you  think  that  Maryanna  has  taken  over  your  wife's  role  in  the 
community? 

I  think  she  has  with  regard  to  the  foundation.   With  regard  to 
other  activities  in  the  community,  she's  been  more  interested  in 
the  business  aspects  of  the  family.   She's  on  the  board  of  the 
company  that's  been  associated  with  the  family.   And  she  goes  to 
Hawaii  once  a  month  to  board  meetings.   She  follows  [what  is] 
happening  quite  carefully.   I  think  she  wants  to  be,  and  has  become, 
a  knowledgeable  businesswoman. 

What  is  the  family  company? 

Alexander  and  B.aldwin.   It  was  founded  by  her  great-grandfather  and 
some  other  members  of  the  family. 

Is  that  still  very  much  oriented  towards  the  Islands? 

Yes,  it's  mainly  an  Island  company. 

Was  your  wife  not  particularly  interested  in  the  company? 

Not  as  intimately  as  Maryanna. 

What,  again,  is  Maryanna 's  background  as  a  college  major? 

She  went  to  Stanford  and  graduated  in  anthropology.   She  went  to 
Hamlin  School  first  for  two  years,  and  then  we  sent  her  to  Milton 
Academy  in  Milton,  Vermont,  for  the  last  two  years.   She  was  the 
first  girl  ever  accepted  from  the  West  [at]  Milton.   It  was  really 
quite  a  thing  for  them  to  accept  somebody  from  way  out  in  the  wilds 
in  San  Francisco. 


Hughes:    I'm  sure  she  did  well  for  the  reputation  of  the  West. 


288 


Gerbode:   She  did  well  enough  to  get  into  Stanford. 

Hughes:   The  other  children  are  not  particularly  interested  in  the  foundation? 

Gerbode:  My  oldest  son  [Frank  Albert  Gerbode]  is,  but  he  will  get  interested 
just  before  the  meeting.   He'll  read  all  the  material,  and  then  he 
gives  an  opinion  about  it.   The  others  haven't  been  asked  to  get 
into  the  foundation  activities.   I  think  they're  interested  in  the 
activities,  but  they  have  their  own  interests.   [John]  Philip,  my 
youngest  son,  is  in  Vermont,  so  it's  very  difficult  for  him  to  do 
anything  locally.  My  youngest  daughter,  Penelope  Ann,  is  busy 
taking  care  of  her  own  family.   She  is  interested  in  the  Nature 
Conservancy  and  the  Oceanic  Foundation.   She  has  her  own  activities 
along  these  lines. 

Hughes:  Would  you  say  that  the  board  of  directors  pretty  much  sees  eye  to 
eye  when  it  comes  to  a  decision  about  whether  to  award  a  grant  or 
not? 

Gerbode:  We  disagree  once  in  a  while,  but  I  think  that  [if  there  is  dissension], 
even  on  the  part  of  one  board  member,  we're  apt  not  to  approve  the 
grant.   Although  sometimes  several  of  us  will  be  in  favor  of  [an 
application] ,  and  one  will  cast  a  dissenting  vote.   Of  course  the 
[majority]  vote  carries. 

Hughes.:  Can  you  make  any  generalization  about  what  the  usual  reason  for  a 
rejection  would  be? 

Gerbode:   There  are  various  reasons.  One  very  good  reason  is  that  they're 

already  sufficiently  funded  or  that  they  have  enough  possibility  of 
being  funded  without  our  help.   Sometimes  the  request  is  for  something 
which  is  not  exactly  in  our  sphere  of  interest. 


Family  Life* 


Hughes: 
Gerbode: 


Was  it  difficult  with  two  very  busy  people  to  keep  the  home  fires 
burning,  so  to  speak? 

I  think  it  was  a  little  hard  on  the  children  in  some  respects.   We 
didn't  spend  as  much  time  with  them  as  we  should  have,  although  we 
always  had  our  vacations  together.   But  the  chances  of  having  me 
come  home  and  read  to  the  children  were  pretty  slim.   However,  I 


*More  information  on  family  life  is  contained  in  the  interview 
with  Maryanna  Gerbode  Shaw. 


289 


Gerbode:   don't  think  the  children  suffered  very  much  from  it.   Maybe 

Philip,  the  youngest  son,  might  have  felt  a  little  bit  left  out 
because  of  our  activities. 

Hughes:   Because  you  were  busier — ? 

Gerbode:   Yes,  busier  than  perhaps  he  thought  we  should  be.   But  he's 

forgiven  us  now,  and  he's  very  much  of  a  family  man  at  the  present 
time.   We  usually  took  the  children  to  the  Hawaiian  Islands  and 
spent  a  month  or  six  weeks  with  them  [during  summer  vacation]. 
That  was  always  very  good  from  the  family  point  of  view. 

[While  the  children  were  growing  up] ,  we  had  a  black  lady  by 
the  name  of  Eloise  Washington  who  was  one  of  the  most  sterling 
characters  I've  ever  known.   She  managed  the  whole  household  by 
herself,  with  occasional  cleaning  people.  Mrs.  Gerbode  never  went 
shopping  and  never  ordered  anything.  Eloise  did  everything,  made 
up  the  menus  and  ordered  the  food  and  watched  the  children. 

Hughes:   Was  she  there  for  most  of  their  growing  up? 

Gerbode:  Yes,  she  was.   She  was  with  us  for  thirty-five  years. 

We've  had  a  series  of  people  since  then,  and  none  of  them  were 
really  very  significant  as  far  as  the  family  is  concerned.  A  very 
fine  Chinese  woman,  Lau  Chun,  takes  care  of  me  now.   She's  excellent. 
She's  a  good  cook.   She  can't  read  English,  and  she  can  hardly 
speak  English,  but  I  manage  with  a  kind  of  pidgin  English  to  convey 
my  wishes.   The  nice  thing  about  a  Chinese  woman  like  that  is  that 
she  doesn't  have  anything  else  to  do. 

Hughes:   Maybe  it's  the  time  to  say  something  about  your  love  of  flowers.   I 
know  you  have  a  greenhouse.   How  old  is  this  love? 

Gerbode:   I  think  I've  always  been  interested  in  a  garden  of  some  kind.   My 
problem  is  that  I  don't  spend  as  much  time  in  it  as  I  should.   I'm 
very  apt  to  get  things  going  and  they'll  do  very  well.   Then  I'll 
switch  to  some  other  part  of  gardening  and  the  first  one  suffers 
from  neglect. 

Right  now  I'm  in  a  position  of  having  to  convert  a  summer 
garden  to  a  winter  garden.   I  was  working  on  this  in  my  mind's  eye 
over  the  weekend.   I  like  planting  vegetables. 


290 


The  Chit  Chat  Club 


Hughes:   Shall  we  talk  a  bit  about  the  Chit  Chat  Club? 

Gerbode:   I  guess  I  got  interested  in  the  Chit  Chat  Club  because  of  a 

professor  of  anthropology  at  Stanford  by  the  name  of  Harold  Fisher. 
He  was  a  Ph.D.   He  was  a  very  good  friend  of  mine,  and  also  even 
before  that  of  my  wife.   She  met  him  in  her  classes  at  Stanford, 
and  he  became  a  kind  of  a  family  friend.   He  was  a  member  of  the 
Chit  Chat  Club.   Incidentally,  it's  over  a  hundred  years  old.   It 
may  be  the  oldest  men's  club  in  California.   If  it  isn't  the  oldest, 
it's  pretty  close  to  being  the  oldest.   So  he  invited  me  to  go  to 
some  meetings,  and  then  finally  they  asked  me  to  become  a  member, 
which  I  then  did. 

Hughes:   Is  that  by  election? 

Gerbode:  They  look  you  over  for  a  couple  of  times,  and  then  send  a  little 
note  around,  "Dr.  So-and-So  has  been  proposed  for  membership.  Do 
you  agree  or  disagree?"  It's  done  very  informally. 

Hughes:   Is  there  any  attention  paid  to  what  your  career  is? 

• 

Gerbode:  Not  really.   The  membership  has  been  rather  heavily  weighted  toward 
lawyers  and  judges,  with  some  professors,  throughout  the  years 
since  I've  been  a  member,  which  is  I  guess  about  twenty  years  now. 

Hughes:   It  was  founded  in  1874.   Do  you  know  what  the  original  purpose  of 
the  club  was? 

Gerbode:   I  think  just  to  get  together  and  talk.   That's  why  they  call  it 

Chit  Chat.   It  was  [modelled  after]  a  similar  club  in  London.   In 
fact,  Samuel  Jonson  belonged  to  a  little  club  like  that.   They 
used  to  meet  in  a  restaurant  in  the  City  of  London.   The 
restaurant's  still  there,  incidentally. 

The  Bohemian  Club  started  the  same  way.   It  started  as  a  small 
club  that  met  once  a  week  in  an  apartment  in  what  is  now  the 
financial  district.   They  were  writers  and  doctors  and  engineers. 
There  were  just  a  handful  of  them.   But  they  started  getting 
interested  in  music  and  the  arts.   They  went  on  and  became  what  is 
presently  now  a  very  large  club,  while  the  Chit  Chat  Club  has  always 
been  small.   It's  always  been  maybe  fifteen  or  twenty  members.   We 
never  wanted  to  be  big.   We  wanted  to  sit  around  one  dining  table 
conveniently,  and  we  wanted  to  have  it  small  so  that  everybody  at  a 
meeting  could  have  something  to  say. 


291 


Hughes:   What  is  the  format  of  a  meeting? 

Gerbode:   The  format  has  been  the  same  forever.   We  meet  for  cocktails  at 
six  o'clock,  and  for  many  years  this  was  at  the  University  Club. 
Now  we  meet  in  a  special  room  at  the  [Grace]  Cathedral.   We  meet 
around  a  big  table  and  have  a  cocktail  or  two,  and  then  precisely 
at  six  thirty  we  go  down  to  the  dining  room  [and]  sit  around  a 
U-shaped  table.   There  is  a  permanent  secretary  and  a  speaker  at 
every  meeting.   The  chairman  of  the  meeting  is  the  speaker  of  the 
previous  meeting.   We  sit  around  this  table,  and  we  have  a  dinner, 
usually  selected  by  the  secretary,  with  good  wines,  which  usually 
takes  about  forty  minutes.   And  then  there's  the  speaker.   The 
subject  that  he's  going  to  talk  about  is  announced  by  letter  a 
couple  of  weeks  before  the  meeting,  so  that  you  have  a  general  idea 
of  what  he's  going  to  talk  about.   But  the  trick  of  the  matter  is 
that  they  usually  couch  the  name  of  the  talk  in  euphemistic  terms 
so  you  can't  be  quite  sure,  so  that  some  smart  aleck  won't  arrive 
and  know  more  about  the  subject  than  the  speaker.   Usually  there 
is  one  smart aleck  who  knows  more  about  it  anyway. 

Hughes:    But  it's  not  the  intention  for  the  members  to  do  a  lot  of  research 
before  the  meeting. 

Gerbode:  No,  it  isn't.  If  one  of  the  members  guesses  what  it's  about  and 
he's  interested  in  that  subject,  he's  apt  to  do  a  little  reading 
on  it. 

Hughes:   That  implies  that  there  is  a  time  for  question  and  answers. 

Gerbode:   Yes.   Usually  [the  talk  is]  read  from  a  manuscript,  and  it  usually 
takes  about  half  an  hour. 

Hughes:   That's  a  fairly  formal  presentation? 

Gerbode:   Yes,  it  is.   Then  the  chairman,  who  is  the  previous  speaker,  will 
ask  people  around  the  table  to  comment  on  the  talk. 

Hughes:  Does  the  Chit  Chat  Club  do  any  publishing? 

Gerbode:  All  the  talks  are  turned  over  to  the  Stanford  Library. 

Hughes:  Why  Stanford? 

Gerbode:  I  suppose  because  way  back  several  members  were  Stanford  faculty. 

Hughes:  The  topics  of  the  talks  are  left  entirely  up  to  the  speaker? 


292 


Gerbode:   Entirely  up  to  the  person.   He  tries  not  to  speak  about  something 
that's  been  discussed  previously. 

Hughes:   These  are  scholarly  presentations? 
Gerbode:  Yes.   They're  not  humorous. 

Hughes:   Just  to  give  an  idea  of  the  sort  of  talks  that  occur,  I  wrote  down 
the  titles  of  the  six  of  yours  that  I  found.   The  first  was  "The 
Crisis  at  the  University  of  California."  That  was  given  in 
January,  1965,  right  in  the  middle  of  the  Free  Speech  Movement. 

Gerbode:   I  had  given  talks  before  that. 
Hughes:   You  don't  have  copies. 

Gerbode:  There's  a  very  good  one  on  the  French  Impressionist  painters,  and 
I  don't  know  what  happened  to  that  manuscript. 

Hughes:   Nineteen  sixty-five  was  the  first  one.   Then  they  came  rather  fast 
and  furious.  You  gave  another  in  1967  called  "Animals  and  Man," 
which  was  about  research  on  the  social  relationships  of  animals. 
Then  "Medical  Manpower  in  Our  Changing  Times,"  which  was  in  May, 
1970,  about  the  shortage  of  doctors  in  this  country  and  some 
possible  solutions.   "Traveling  Behind  the  Iron  Curtain"  in  1972. 
"The  Barking  Dog"  in  1973".   And  then  "In  Pursuit  of  Aphrodite,."  which 
didn't  have  a  date  on  it. 

Gerbode:   I've  forgotten  the  date. 
Hughes:   How  did  you  choose  these  topics? 

Gerbode:  [laughs]  I  don't  know.  I'm  constantly  thinking  what  I'm  going  to 
have  to  do  the  next  time.  It's  like  painting  that  picture  for  the 
Christmas  card.*  It's  on  my  mind  all  the  time. 

Hughes:   Is  it  done  on  a  rotation  basis? 
Gerbode:   Yes. 

Hughes:   How  long  do  you  expect  to  spend  on  the  preparation  of  a  Chit  Chat 
talk? 

Gerbode:  Oh,  I  have  to  spend  a  lot  of  time,  because  I'm  not  very  smart. 


*After  he  took  up  painting,  Dr.  Gerbode  each  year  sent  a  reproduction 
of  one  of  his  paintings  as  a  Christmas  card. 


293 


Hughes:   Oh,  come!   [laughter] 

I  was  very  impressed  with  the  bibliography  for  the  Sir  Francis 
Drake  paper,  which  went  on  for  pages.  Did  you  really  look  at  all 
that? 


Gerbode:  Yes,  I  did.  I  really  researched  him.  I  really  think  that  people 
don't  realize  what  an  important  person  he  was  in  the  formation  of 
the  British  empire. 

Hughes:  Do  you  have  any  opinion  on  the  famous  Drake  plate  which  resides 
in  The  Bancroft  Library  at  Berkeley? 

Gerbode:   I  remember  when  it  was  found,  and  [that]  Mr.  Alan  Chickering,  the 
lawyer,  was  excited  about  it.   He's  the  one  that  got  it  into  the 
Bancroft  Library  and  made  a  big  thing  about  it.   I  have  no  idea 
about  whether  it's  really  authentic  or  not.   If  it's  not  authentic, 
somebody  did  a  powerfully  good  job  in  faking  it. 

Hughes:   What  about  notable  members  of  the  Chit  Chat  Club? 

Gerbode:   Joel  Hildebrand  was  one  of  the  famous  ones.   He  was  a  long-time 

and  very  interesting  member.   He  finally  had  to  give  up  because  of 
old  age;  he  couldn't  get  back  and  forth  across  the  bay.   Professor 
Robinson  of  Stanford,  a  famous  historian,  was  a  long-time  member. 
He  finally  gave  up.   A  very  famous  astronomer — I  can't  remember 
his  name  just  now — was  a  member  for  a  long  time.   One  of  the  judges 
is  Ben  Duniway,  who  is  quite  a  liberal  superior  court  judge,  also 
a  trustee  of  Stanford  University.   He's  been  a  member  for  a  long, 
long  time.   There's  a  Judge  Searles,  who's  a  well-known  judge 
currently.   There  was  Langley  Porter,  a  pediatrician,  for  whom  the 
Langley  Porter  [Institute]  is  named.   He  was  a  real  giant  in  the 
community.   One  of  the  good  things  about  him  was  that  he  liked  me. 

Hughes:   Was  that  unusual? 

Gerbode:  Well,  he  took  a  personal  interest  in  me,  which,  as  a  young  man, 
was  very  flattering.  I  don't  know  why.  I  never  asked  him.  He 
invited  me  to  his  house  to  meet  other  friends  of  his. 

Hughes:   Did  he  have  any  particular  interest  in  the  field  of  cardiovascular 
surgery? 

Gerbode:   No. 

Hughes:   Did  that  friendship  have  any  bearing  on  your  subsequent  career? 


294 


Gerbode:   No,  I  don't  think  so.   It  was  something  I  was  flattered  to  have. 
Hughes:   What  was  he  like  as  an  individual? 

Gerbode:   He  was  a  big  man.   He  was  vigorous  in  his  attitudes  and  his 

approaches  to  life.   He  always  made  good  decisions.   He  was  highly 
respected  as  a  physician  and  had  an  enormous  practice.   He  managed 
a  lot  of  things  at  the  same  time.   For  that  reason  he  was  a  man 
of  considerable  stature. 

Hughes:   You  mean  much  more  than  medicine? 

Gerbode:  Yes.  He  was  very  interested  in  the  community,  which  is  unusual  for 
a  very  busy  practitioner.  A  similar  man  was  Chauncy  Leake,  who  was 
active  in  Chit  Chat. 

A  very  well-known  anthropologist  by  the  name  of  Harold  Fisher, 
who  was  a  very  prominent  professor  from  Stanford ,  [was  also  a 
member].   Currently  there  are  three  judges  and  three  lawyers.   One 
cleric ,  Dean  Julian  Bartlett ,  who  is  the  dean  emeritus  of  Grace 
Cathedral,  is  a  member.   He  comes  to  the  meetings  quite  regularly. 

Hughes:   What  are  the  numbers  involved? 

Gerbode:  There  are  usually  about  twelve  to  fifteen  members  present.  I  think 
the  total  membership  is  about  twenty. 

Hughes:   Does  the  group  tend  to  be  fairly  critical? 

Gerbode:   They  can  be  very  critical.   If  they  know  something  about  the  field 
and  the  man  has  made  some  erroneous  statements,  they'll  point  [them] 
out  to  him. 

Hughes:   So  the  question  and  answer  period  can  be  quite  lively. 

Gerbode:  Yes.   It's  more  of  a  discussion  period. 

[Interview  12:  October  23,  1983  ]//# 
Hughes:   Shall  we  talk  about  your  children. 


The  Home  on  Divisadero  Street 


Gerbode:  Yes.   After  I'd  been  in  Germany  for  a  year  just  before  the  war  with 
Professor  Borst  in  Munich,  we  came  back  and  I  had  an  appointment 
as  an  assistant  resident  on  the  surgical  service  at  Stanford  in 


295 


Gerbode:   San  Francisco.   We  had  children  coming  and  we  decided  since  we 
were  going  to  have  a  modestly  large  family,  we'd  better  get  a 
house  to  accommodate  them.   So  we  looked  at  lots  of  property  and 
houses  and  decided  the  best  thing  to  do  would  be  to  get  some 
property  and  build  a  house  somewhere  near  the  good  schools ,  which 
is  Pacific  Heights  in  San  Francisco.   We  actually  had  our  eyes 
on  Grant  School,  which  was  a  good  public  school  with  a  long  history 
on  Pacific  Avenue. 

Meanwhile  we  had  rented  a  house  on  Green  Street.   We  finally 
found  this  lot  on  the  corner  of  Divisadero  and  Broadway.   The  real 
estate  people  wanted  an  outrageous  amount  of  money  for  it.   The 
contractor,  Mr.  Sophus  Stockholm,  was  a  good  friend  of  mine  and 
also  a  very  good  friend  of  the  Pope  family  who  owned  the  property. 
So  he  went  to  the  Pope  family  directly  and  said,  "Look,  there's 
this  young  doctor  who  would  like  to  build  a  house  on  that  corner. 
How  much  would  you  really  take  for  it  straight  from  him?"   So  they 
gave  us  an  extremely  good  price  on  the  lot.   It  was  a  hundred  feet 
each  way ,  on  the  corner ,  with  a  nice  wall  around  it ,  which  we 
decided  to  keep. 

We  also  had  a  very  good  friend  by  the  name  of  Bill  Wurster  who 
was  a  famous  architect  in  San  Francisco.   We  liked  his  sort  of 
modern  style  of  building.   It  wasn't  modernistic.   It  was  modern 
Georgian  style.   So  among  all  of  us,  we  designed  this  house.   When 
the  plans  were  complete,  we  discovered  that  it  was  going  to  cost 
me  about  five  dollars  and  sixty-five  cents  a  square  foot.   I  went 
to  Bill  and  I  said,  "Bill,  I  can't  afford  this."  He  said,  "Frank, 
it's  all  relative.   Go  borrow  the  money."   [laughter]  He's  never 
said  a  truer  thing  in  his  life.   I  couldn't  build  that  house  for 
eighty  dollars  a  square  foot  now. 

So  we  borrowed  the  money  and  went  ahead  with  building  it.   It 
was  finished  within  a  year.   Sophus  Stockholm,  a  very  good  friend, 
did  a  meticulous  job  in  building  it.   I  had  a  few  arguments  with 
Bill  Wurster  about  certain  parts  of  it,  because  he  was  a  very 
determined,  somewhat  stubborn  man.   But  I  won  all  the  arguments.   I 
had  other  arguments  with  him  later  about  a  house  for  my  sister  and 
a  house  in  Sugar  Bowl.   But  I  finally  won  all  the  arguments. 

So  the  house  was  finished.   It  was  a  big  house  for  an  assistant 
resident  in  surgery  to  owr . 

Hughes:   What  year  was  the  house  built? 
Gerbode:   It  was  1938. 


296 


Hughes: 
Gerbode: 


How  could  you  have  been  sure  that  you'd  stay  in  San  Francisco? 


Hughes : 
Gerbode : 


Hughes : 
Gerbode: 


I  just  decided  I'd  be  here, 
five  times  later. 


I  made  that  decision  about  four  or 


It  [is]  a  lovely  house.   We  didn't  have  enough  furniture  to 
complete  it.   Meanwhile,  my  father,  who  was  a  contractor,  had  hurt 
his  back  badly  in  a  fall  from  a  scaffold  and  couldn't  be  a 
contractor  any  longer.   But  he  could  work  maybe  two  or  three  hours 
a  day.   So  he  bought  a  lot  of  tools  and  equipment  and  started 
making  furniture  at  home  just  for  fun. 

They  were  in  Piedmont? 

Yes.   They  had  a  little  house  over  there,  and  he  had  a  shop  in  the 
basement.   So  he  decided  to  make  us  some  furniture.   He  made  the 
dining  room  table  and  some  beds  for  the  children  and  a  few  other 
odds  and  ends.   It  took  him  a  long  time  to  do  it,  because  he  could 
only  work  a  couple  of  hours  a  day.   He  was  about  seventy-eight  or 
eighty  years  of  age.   So  it  gave  him  something  to  do  and  he  enjoyed 
it. 

Had  he  ever  done  anything  like  that  before? 

He  was  trained  in  fine  cabinetwork  and  construction,  because  that's 
what  he  did  when  he  was  a  contractor.   He  would  not  only  build  a 
house,  but  he  designed  all  the  cabinetwork  inside  as  well. 

So  we  got  some  furniture  from  him,  and  we  bought  some.   We 
had  some  pieces  which  we'd  inherited  through  the  family,  and  put 
together  a  reasonably  well  furnished  house. 

The  house  is  on  a  corner  lot  on  Divisadero  and  Broadway,  and 
the  lot  falls  off  rather  steeply  down  Broadway.   That  means  that  if 
you  build  the  house  level  with  Divisadero  Street,  the  back  of  the 
house  goes  down  about  sixteen  or  more  feet.   So  that  meant  that  by 
doing  a  little  excavating  in  the  front ,  we  could  have  a  full 
basement  which  would  be  built  on  rock.   Part  of  it  turned  out  to  be 
a  playroom  for  the  children.   I  was  very  interested  in  doing 
photography  as  a  hobby  at  that  time,  so  I  made  a  photograph 
developing  room.   I  did  a  lot  of  developing  pictures  and  printing 
down  there.  The  children's  playroom  and  the  photography  room 
became  an  apartment  during  the  war.   Donovan  and  the  Secret  Service 
took  it  over  for  the  Navy.   [Bob  Haynie  and  Herbert  Little]  were 
down  there  during  the  war  as  our  guests,  designing  programs  which 
would  frustrate  the  Japanese  on  the  air. 


297 


Hughes:    How  did  that  connection  come  about? 

Gerbode:   I  guess  they  wanted  to  have  a  place  in  a  neighborhood  where  they 

wouldn't  be  obvious.   It  was  easier  to  bury  themselves  in  somebody's 
house  than  it  was  downtown  in  an  apartment  or  an  office.   So  I 
think  they  remained  anonymous  there  during  the  war. 

It  proved  to  be  a  very  fine  house  to  raise  children.   The 
block  is  flat  in  front,  so  the  children  could  play  on  the  broad 
sidewalk.   I  had  figured  this  all  out  in  advance  as  well.   We 
made  a  play-yard  for  them  in  the  back  where  they  could  have  a 
jungle  gym  and  a  few  things  like  that. 


Children 


Wallace  Alexander  Gerbode 


Gerbode:   We  initially  put  all  the  children  into  Grant  School,  but  the  oldest 
son,  Alec,  never  had  any  homework.   I  asked  Alec,  "Why  don't  you 
have  any  homework?"  He  said,  "I  do  it  all  in  just  a  few  minutes 
at  school ,  and  then  the  teacher  assigns  me  little  chores  to  do 
around  the  classroom  like  cleaning  the  erasers  and  running  errands." 
So  I  went  around  and  found  the  homeroom  teacher  at  the  school  and 
said,  "I  have  a  son  here  who  is  in  your  class  by  the  name  of  Alec 
Gerbode.   I  was  just  wondering  how  you  think  he's  getting  along." 
She  said,  "Now  which  one  is  he?" 

So  I  said  [to  myself] ,  that  means  that  she  doesn't  really  know 
the  students  in  the  class.   So  we  pulled  him  out  and  put  him  in  a 
new  little  private  school  on  McAllister  Street  called  Town  School, 
which  was  just  being  started.   There  weren't  many  children  in  it, 
but  the  instruction  was  quite  good.   Then  he  stayed  when  Town 
School  moved  to  a  new  location  on  Jackson  Street.   We  helped  them  a 
bit  financially  to  get  moved  over  there,  helping  to  buy  the  property 
from  some  nuns. 

Then  instead  of  sending  Maryanna  to  Grant  School,  we  put  her  in 
the  Hamlin  School,  and  subsequently  Penny  and  Maryanna 's  daughter, 
Sarah,  went  there,  too.   Philip  and  Sarge  went  to  Town  School.   It 
was  all  in  the  neighborhood,  [so]  they  could  walk  to  school,  which 
is  a  great  thing. 


298 


Susan  Gerbode 


Gerbode:  We  lost  a  daughter,  Susan.  Just  when  I  was  getting  ready  to  go 

overseas  during  the  war,  Susan  was  born,  and  she  died  a  couple  of 
days  after  birth.  We  don't  know  why.   I've  always  felt  that  maybe 
she  had  too  much  medication  or  somebody  didn't  pay  attention  to 
her.   She  may  have  aspirated  some  mucus. 

Hughes:   Did  she  seem  healthy  when  she  was  born? 

Gerbode:  Yes,  she  seemed  quite  healthy.   The  pediatrician  thought  she  was 
perfectly  all  right.   That  was  pretty  hard  for  my  wife,  to  lose  a 
little  girl  and  then  have  me  leave  shortly  thereafter  in  the  army. 

Hughes:   Do  you  want  to  say  something  about  what  the  children  are  doing  now? 


Wallace  Alexander  Gerbode  (Continued) 


Gerbode:  Alec,  the  oldest  boy,  went  to  Exeter.   My  good  friend  Paul  Bissinger, 
who  lived  on  the  corner  of  Divisadero  and  Pacific,  had  a  son,  Paul, 
Jr.,  and  Alec  and  Paul,  Jr.  were  very  good  friends.   The  two 
families  decided  to  send  our  boys  East  to  school.   The  both  got  into 
Exeter.  Alec  did  very  well  at  Exeter.   In  addition  to  having  a 
good  academic  record ,  he  was  on  the  swimming  team  and  set  some  new 
records  in  the  school  in  swimming.   He  was  a  tall,  very  handsome 
young  man.   He  looked  very  much  like  Maryanna's  oldest  son,  who's 
also  named  Alec. 

In  any  event,  Alec  then  went  to  Stanford.   When  he  got  there  he 
got  into  some  advanced  classes  because  of  what  Exeter  provided.   He 
went  through  his  first  year  quite  easily.   Then  after  the  summer 
vacation  he  went  back  to  Stanford  as  a  sophomore  and  was  at  an 
evening  party,  and  driving  home  there  was  a  head-on  collision  and 
he  was  killed. 


Maryanna  Gerbode  Shaw 


Gerbode:  Maryanna  had  gone  to  Hamlin  School  for  two  years  in  high  school  and 
then  decided  that  she'd  like  to  get  out  of  Hamlin,  since  she'd  been 
there  all  through  grammar  school  and  high  school.   So  we  looked 
around  and  decided  that  we'd  send  her  East  too.   The  most  difficult 


THE  GERBODE  CHILDREN 


LEFT:  Left  to  right, 
Wallace  Alexander  Gerbode, 
Frank  Albert  Gerbode,  III, 
Maryanna  Gerbode, 
ca.  1940. 


BELOW:  Left  to  right, 
Frank  Albert  Gerbode,  III, 
Maryanna  Gerbode  Shaw, 
Penelope  Ann  Gerbode  Jay, 
John  Philip  Gerbode, 
1985. 


299 


Gerbode:   school  to  get  into  in  the  East  for  a  girl  was  Milton  Academy  in 

Milton,  Mass.   They'd  never  taken  anybody  from  California.   I  guess 
it  was  too  far  away  from  New  England.  But  in  any  event,  we  took 
her  back  there  and  she  was  interviewed.   The  school  here  wrote 
very  good  recommendations,  so  they  accepted  her  in  the  junior  high 
school  class,  the  first  time  it  ever  happened.   She  felt  very 
alone  there  for  a  while,  because  the  Eastern  girls  stick  together. 
Many  of  them  had  known  each  other  forever,  and  they  are  inclined  to 
be  a  little  bit  impressed  by  their  Eastern  connections  and  so  forth, 
But  she  is  a  very  friendly  person,  and  she  soon  made  her  way  with 
the  staff  and  with  the  teachers  and  managed  a  few  friends  among 
these  Eastern  girls.   She  knows  more  about  it  than  I.   I'm  only 
telling  you  what  I  gather  in  speaking  with  her  about  it.   Eventually 
she  decided  she  would  go  to  Stanford.   She  applied  and  got  into 
Stanford  as  a  freshman.   When  she  was  there  she  wondered  what  to 
take  and  decided  that  anthropology  might  be  a  good  thing. 

We  also  were  very  good  friends  with  Fee  Keesing ,  who  is  a 
professor  of  anthropology  at  Stanford.   She  liked  him  and  liked 
what  he  was  doing.   He  was  an  expert  on  Polynesia,  and  that,  I  guess, 
intrigued  her  a  little,  too,  because  of  her  [Hawaiian]  Island 
connections.   So  she  went  through  Stanford  and  finally  graduated  in 
anthropology. 

During  her  senior  year  she  met  Joe  Shaw,  who  was  a  premedical 
student,  and  they  were  married.   Then  he  went  through  medical  school 
at  Stanford,  and  then  went  East  for  training,  went  through  a  full 
residency  in  orthopedic  surgery.   They  had  three  children. 

Hughes:   The  children  must  be  close  in  age. 

Gerbode:   Yes,  they  are  a  couple  of  years  apart  and  fortunately  got  along  very 
well  together,  and  she  gets  along  very  well  with  them.   We  had 
bought  this  old  house  on  Pacific  near  Steiner,  the  oldest  house 
in  Pacific  Heights,  built  in  1852.   They  were  about  to  demolish  it 
and  put  up  some  townhouses  on  the  lot.   So  we  heard  about  it  and 
bought  it,  and  finally  had  it  classified  as  an  historic  building. 
We  rebuilt  it,  modernized  the  inside  of  it.   For  example,  there 
was  a  dirt  basement ,  and  we  wanted  to  cover  it  over  with  cement ,  so 
we  had  to  dig  it  out  and  level  it  underneath  the  house. 

[telephone  interruption] 

Gerbode:   As  we  started  redoing  the  house  we  found  the  old  gas  light  shades, 

which  are  made  out  of  very  pretty  old  glass.   We  saved  most  of  those 
and  were  able  to  put  those  into  a  fixture  in  each  room,  which  was 
then  electrified.   That  worked  out  very  well.   And  in  the  basement, 
in  addition  to  finding  some  other  things,  we  found  some  broken  pieces 


300 


Gerbode:   of  marble.   We  put  them  all  together,  and  it  turned  out  to  be  a 
marble  fireplace  which  somebody  had  taken  out  and  broken  up  and 
stuck  in  the  basement.   So  we  put  all  these  pieces  together  and 
made  a  very  handsome  fireplace  in  the  living  room,  which  was 
probably  exactly  the  way  it  was  in  the  old  days. 

In  any  event,  we  had  a  lot  of  fun  with  that  house.   Then  we 
gave  it  to  Maryanna  when  she  moved  out  from  the  East ,  when  she  was 
married  to  Joe  Shaw.   She  has  lived  there  ever  since.   In  fact, 
she's  redone  it  a  couple  of  times  since  then  herself,  but  retained 
all  the  fine  personality  of  a  really  beautiful  Victorian-type  house. 

Hughes:   Is  it  decorated  in  that  fashion  as  well? 
Gerbode:  Well,  it's  modern  and  Victorian. 

Hughes:   Do  you  want  to  say  more  about  Maryanna?  You've  spoken  about  her 
work  with  the  [Gerbode]  Foundation. 

Gerbode:   Maryanna,  in  the  process  of  raising  these  children,  got  involved 
with  various  things  in  San  Francisco,  very  much  like  her  mother. 

In  more  recent  years  she's  gone  on  the  board  of  Alexander  and 
Baldwin,  which  is  a  firm  with  which  the  family  has  had  something 
to  do  for  over  a  hundred  years.  She's  the  first  woman  to  be  on 
that -board  in  a  hundred  and  fifty  years  of  its  existence,  and  she's 
doing  a  very  good  job  there. 

In  addition  to  that  she's  gone  on  the  board  of  the  University 
of  the  Pacific  as  a  trustee,  which  she  likes  very  much  as  well. 

Hughes:   How  do  these  things  occur? 

Gerbode:   These  things  occur  because  somebody  spots  you  and  they  have  a  place 
and  they  want  you  to  fill  in  that  spot. 

Hughes:   So  she  had  shown  herself  already  to  be  a  capable  young  woman. 
Gerbode:   That's  right.  And  people  like  her. 


Frank  Albert  Gerbode  III 


Gerbode:   My  son  Sarge,  who  is  Frank  Gerbode  III,  was  admitted  after  Town 

School  to  both  Andover  and  Exeter  and  went  back  to  the  East  Coast 
to  see  which  one  he  wanted  to  go  to.   Exeter  has  a  very  proud 


301 


Gerbode:   headmaster  who  thinks  that  Exeter  is  the  end  of  the  world  in 

preparatory  schools  and  believes  that  anyone  who's  been  admitted 
to  Exeter  has  been  admitted  to  heaven,  more  or  less.   [laughter] 
So  Sarge  first  went  to  Andover  and  looked  it  over,  and  then  he  went 
to  Exeter  and  looked  it  over,  and  then  he  went  to  see  the  head 
master.   The  headmaster  said,  "Aren't  you  happy  that  you  were 
finally  selected  like  your  brother  to  go  to  Exeter?"  He  said, 
"Well,  I  came  here  to  tell  you  that  I've  decided  to  go  to  Andover." 
[laughter]   I  think  the  headmaster  fell  through  the  floor.   But 
anyway,  at  least  he  had  the  courage  and  the  decency  to  go  tell  the 
headmaster  what  his  decision  was.   So  he  went  to  Andover  and  did 
very  well. 

He  also  got  into  Stanford  and  got  advanced  standing  in  several 
courses,  English  I  think,  for  one.   He  went  through  Stanford  and 
graduated.   He's  always  been  interested  in  philosophy,  so  he  said, 
"I'd  like  to  go  to  England  and  try  to  get  a  Ph.D.  in  philosophy." 
So  he  was  admitted  to  Cambridge,  which  is  unusual  as  well,  and  was 
about  two-thirds  of  the  way  through  the  year  when  he  wrote  me  a 
letter  saying  that  he'd  decided  that  he  didn't  want  to  get  a  Ph.D. 
in  philosophy,  that  he  thought  he'd  get  an  M.D.  degree,  because  he 
thought  he  could  do  more  with  an  M.D.  degree,  which  is  certainly 
true.   So  he  finished  his  year  at  Cambridge,  came  back,  and  then 
had  to  take  some  premedical  subjects,  which  he  did  at  the  University 
of  California  and  Stanford.   Then  he  applied  to  several  medical 
schools.   He  got  into  all  of  them,  including  Harvard.  Some  of  my 
friends  at  Harvard  were  delighted  that  he  was  admitted,  and  they 
thought  of  course  he'd  go  there.   But  again,  he  wrote  and  told  them 
he  didn't  want  to  go  to  Harvard  and  decided  to  go  to  Yale,  because 
Yale  didn't  have  any  examinations.   You  took  the  national  board 
examinations,  rather  than  taking  course  examinations. 

Hughes:   All  the  way  through? 

Gerbode:   Pretty  much  all  the  way  through.   So  he  graduated  from  Yale  Medical 
School.   Then  he  took  a  full  residency  in  psychiatry,  both  at  Yale 
and  at  Stanford.   He  now  practices  a  form  of  psychiatry.   He's  a 
very  intelligent  young  man,  almost  middle-aged  now,  I  guess,  isn't 
he?  He  was  married  to  the  daughter  of  a  professor  at  Stanford, 
Rodney  Beard.   Julie  is  extremely  bright,  Phi  Beta  Kappa  at  Stanford. 
They  were  married  when  he  went  to  England.  I  was  not  terribly  happy 
with  that  marriage,  because  I  thought  zhe  two  of  them  were  too  much 
alike.   I  guess  they  decided  that,  too,  because  eventually  they  got 
divorced.   He  had  two  sons,  Collin  and  Ian,  by  Julie,  and  they're 
now  teenagers.   Then  about  three  years  ago  he  met  a  girl  from  South 
Africa  by  the  name  of  Gail.   They  were  married  in  my  house,  and  they 
have  a  daughter,  Sharon.   Gail  is  a  very  charming  young  lady,  and 
the  daughter  is  very  charming,  too. 


302 


Hughes:   Do  they  live  down  the  peninsula? 

Gerbode:   They  have  a  beautiful  country  style  house  in  Woodside. 

The  Adoption 


Gerbode: 


Hughes : 
Gerbode: 


Hughes : 
Gerbode: 


Then  [there  is]  Penny,  the  youngest  daughter,  the  adopted  daughter, 
and  her  brother,  Philip,  who's  adopted  as  well. 

After  Alec  was  killed  in  that  accident,  Mrs.  Gerbode  was 
shaken  very  badly,  as  I  was,  too.   We  decided  that  it  might  be 
better  for  everybody  concerned  if  we  adopted  some  children.  At  that 
point  we  could  afford  to  do  it.   So  we  heard  about  two  English 
children  who  were  abandoned  by  their  mother  and  father  and  were 
living  with  their  grandmother.   We  investigated  the  situation.   They 
seemed  like  nice  children. 

How  old  were  they? 

They  were  three  and  four,  more  or  less.   So  we  went  through  the 
rather  complicated  process  of  adopting  them.  We  had  to  go  to 
England  to  get  some  papers  signed  by  the  father.   I  think  the  mother 
had  disappeared.  The  father  didn't  want  the  children,  so  that 
turned  out  very  well.   It  was  a  little  difficult  to  bring  the 
children  up  to  standards  academically,  because  they  had  not  been 
trained  very  much.   We  found  out  that  there  was  a  very  famous  nanny 
around  by  the  name  of  Miss  Elsie  Jeeves.   Jeevie,  as  we  called  her, 
said  that  she  would  come  and  live  with  us  and  help  to  raise  the 
children,  so  she  did.   Jeevie  had  raised  four  or  five  well-known 
children  in  Pacific  Heights  previously.   She's  a  well-known  character. 
At  that  point  she  was  about  seventy  years  old,  but  very  strong. 
She  used  to  take  long  walks  like  a  Scotch  mistress.   She  was  very 
good,  very  strict  with  the  children.   They  learned  to  respect  her, 
which  is  very  important,  even  though  she  was  really  hard  on  them. 

Was  there  quite  a  period  of  adjustment? 

It  was  very  hard  on  Mrs.  Gerbode.   They  were  completely  undisciplined 
and  had  really  never  learned  good  study  habits  or  anything.   It 
was  really  difficult  to  get  them  brought  around.   But  Jeevie  helped 
a  lot.   The  Town  School  took  Philip,  and  Hamlin's  took  Penny. 


303 


John  Philip  Gerbode 


Gerbode:   After  Philip  finished  Town  School,  we  sent  him  to  Cambridge  School 
in  Weston,  Mass.   He  did  reasonably  well  academically  there ,  enough 
to  get  into  Middlebury  College  in  Vermont.   He  got  to  know  some 
sons  of  prominent  Eastern  families  who  were  filled  with  their  own 
way  of  solving  the  problems  of  the  world,  one  of  which  was  to  buy 
some  farmland  and  put  underprivileged  people  and  ex-convicts  on  it, 
and  have  them  learn  how  to  do  farming  and  become  good  citizens 
through  work  and  having  responsibilities.   But  unfortunately  this 
proved  to  be  a  complete  failure,  because  they  didn't  do  what  they 
were  supposed  to  do.   [Problems  arose]  in  various  ways.   I  don't 
know  in  which  ways.   But  at  least  the  idea  didn't  turn  out  very  well. 
Philip  meanwhile  got  to  like  the  seasons  and  Vermont  and  decided 
he  wanted  to  stay  there.   He  had  not  graduated  from  Middlebury. 

Hughes:   Had  he  worked  with  this  organization? 

Gerbode:   Yes.   Two  or  three  had  enough  money  to  do  this.   Meanwhile,  he  had 
been  to  art  school  in  San  Francisco  and  also  Boston,  but  he  was 
apparently  not  getting  along  well  enough  to  be  satisfied  with  it. 

Meanwhile  we'd  given  him  some  money  and  he  bought  a  small  farm 
with  a  small  barn  and  a  few  cows  and  decided  to  learn  how  to  be 
a  dairy  farmer.   He  did  all  this  himself.   He  milked  the  cows  with 
one  other  boy  and  arranged  the  contracts  with  the  people  who 
bought  the  milk.   When  I  visited  him,  he  smelled  like  a  cow.   He 
had  two  piles  of  clothes,  one  that  had  been  through  the  washing 
machine;  the  other  which  hadn't.   He'd  take  off  the  dirty  ones,  put 
them  on  the  floor,  and  take  some  from  the  other  stack  and  put  them 
on.  But  I  guess  this  was  his  way  of  getting  into  the  act  seriously. 

When*"my  wife  died,  we'd  had  some  money  put  aside  for  all  the 
children.  So  this  was  divided  up  evenly  among  the  four  children. 
Philip  then  got  enough  money  to  spread  out  a  bit,  and  he  decided 


304 


Gerbode; 


Hughes : 
Gerbode: 

Hughes : 
Gerbode: 


he'd  go  into  it  more  seriously,  and  began  to  buy  property  in  Vermont. 
He  finally  built  a  big,  very  modern  barn  and  a  house  and  sold  some 
property,  bought  some  more  property  and  some  thoroughbred  cows. 
Now  he  has  nearly  two  thousand  acres  of  Vermont  land ,  and  he  milks 
about  two  hundred  and  thirty  cows  a  day,  all  done  very  scientifically. 


Is  he  still  doing  it  himself? 

He  runs  it,  but  he  has  good  people  to  work  for  him  now. 
loves  it. 

How  many  head? 


He  really 


Well,  he  has  about  two  hundred  thirty  milking  cows,  and  he  must  have 
another  fifty  or  sixty  out  in  the  pasture.   He  has  a  sale  every 
once  in  a  while  if  he  gets  too  many  cows.   Since  they're  all 
registered  and  thoroughbred,  he  can  advertise  them  nationally.   He 
has  good  records  on  all  of  them,  so  he  can  say  that  in  this  line  of 
cows  the  production  has  been  so-and-so.   He  once  had  a  national  sale 
and  got  quite  a  bit  of  money  back  [from]  a  brochure  sent  out  to 
breeders  everywhere. 

I  don't  know  whether  we  should  record  this,  but  he's  always  had 
someone  living  with  him,  but  he  never  wanted  to  get  married.   Now 
he  has  a  very  nice  young  lady  living  with  him,  and  they  have  a  baby, 
and  that  makes  it  a  little  more  serious.*  I  have  nine  grandchildren 
now. 

I've  always  gotten  along  very  well  with  Philip.   He's  gregarious, 
very  open  and  cheerful.   Sometimes  he  doesn't  tell  me  things  that 
I  think  he  should.   For  example,  he  decided  to  go  into  stockcar 
racing.   He  had  enough  money  left  over  from  his  farm  to  buy  a 
couple  of  racing  cars  and  to  race  them  on  weekends.   Usually  he 
[races]  for  some  company  or  other  combine.   Of  course  he  knew  that 
this  would  upset  me,  so  he  didn't  tell  me  about  it  until  he'd  just 
about  decided  to  give  it  up.   But  now  he  has  built  another  racer 
and  will  do  ten  races  this  winter. 


Property  on  Kauai** 

Gerbode:  About  twenty-five  years  ago  we  began  to  worry,  since  we  had  so 

many  roots  in  the  Hawaiian  Islands,  that  we  should  have  some  land  for 
the  grandchildren.   We  were  afraid  that  the  Diamond  Head  properties 


1984,  less  than  a  week 
**This  section  was  moved  from  the  interview  on  6/20/83. 


*Philip  was  married  in  Vermont  on  December  1, 
before  his  father  died. 


Papaa,  Kauai 


Frank  Gerbode  1984 


Papaa  Bay,  Kauai 


Frank  G<?rbode  1980 


Kahala,  Oahu 


Frank  Cerbode 


305 


Gerbode:   would  eventually  become  something  else.   We  can't  get  there  any 
more,  because  in  a  family  foundation,  the  family  can't  use  the 
property.   About  twenty-five  years  ago,  my  wife  and  I  started 
buying  property  on  Kauai.   We  have  a  farm  over  there  now,  which 
I've  maintained.   I'm  gradually  buying  the  whole  little  valley.   I 
own  almost  all  of  it  already. 

Hughes:   What  do  you  farm? 

Gerbode:   I  put  cattle  on  it,  and  citrus  fruit,  too.   It's  not  a  money-making 
thing,  but  it  eventually  will  break  even.   Then  it  will  be  something 
that  the  grandchildren  will  have. 

Hughes:  Does  somebody  maintain  it? 

Gerbode:  Yes,  I  have  a  caretaker. 

Hughes:  How  much  time  do  you  spend  there? 

Gerbode:  I  go  over  about  every  two  months.   I  like  it  very  much. 

Hughes:  Is  it  an  old  house? 

Gerbode:   No.   We  first  built  a  prefab  house,  an  extremely  simple  one,  having 
made  a  good  site  for  it,  overlooking  a  bay.   Then  as  time  went  on, 
I  wanted  to  make  it  a  bit  bigger.   The  kitchen  was  like  a  little 
closet.   Since  I  always  ended  up  doing  the  cooking,  I  wanted  to  have 
a  bigger  kitchen,  but  my  wife  didn't  want  to  have  anything  too 
pretentious.   So  I  waited  until  a  year  and  a  half  after  she  died, 
and  then  I  enlarged  the  house,  built  a  bigger  living  room,  and  made 
a  decent  kitchen.   Since  then,  we've  built  another  bedroom.   This 
last  year,  I  rebuilt  the  whole  house  again,  because  it  was  filled 
with  dry  rot.   I  was  afraid  it  was  going  to  start  falling  down. 
So  now  it's  brand  new  but  the  same  [design]  as  it  was. 


Hobbies 


Hughes:    Shall  we  talk  about  hobbies? 

Gerbode:   Yes.   I  have  enough  hobbies  to  keep  me  going,  and  periodically 
there's  competition  between  hobbies  and  work.   In  the  past  work 
has  always  won  out. 

Hughes:   How  long  have  the  hobbies  been  in  your  life? 


306 


Tennis 


Gerbode:  Tennis  was  a  hobby;  I  liked  tennis  a  lot  when  I  was  in  college.   But 
I  was  working  so  hard,  I  really  didn't  have  time  to  play  it  the  way 
I  wanted  to  play  it.   I  took  some  lessons  from  a  very  good  pro  and 
played  in  some  minor  tournaments.   [It]  became  a  pastime  more  than 
anything  else,  until  about  six  years  ago  when  I  hurt  my  arm  on 
my  boat,  so  I  couldn't  play  tennis  anymore.   The  biceps  muscle  is 
all  bunched  up.   I  tore  it  loose. 


Carpentry 


Gerbode:   I've  always  liked  working  in  a  shop,  repairing  furniture  or  making 
things  once  in  a  while. 

Hughes:   Do  you  have  a  shop? 

Gerbode:  Yes,  there  are  a  whole  bunch  of  unfinished  projects  there.   I'm 
inclined  to  try  to  repair  things. 


Photography 


Hughes:   You  mentioned  photography. 

Gerbode:   I  did  photography  very  seriously.  When  I  was  in  Germany  I  bought  a 
Leica  camera  and  took  some  lessons  from  a  very  fine  photographer 
and  had  a  little  darkroom  in  that  house  which  we  rented  in  Germany, 
and  did  a  lot  of  developing  myself.   Then  when  we  built  the  house 
in  San  Francisco,  I  had  a  darkroom  where  I  could  continue  it.   I 
did  hundreds  and  hundreds  of  pictures.  Where  they  all  are  now,  I 
don't  know. 

Hughes:   Did  you  ever  enter  competitions? 

Gerbode:  No,  but  I  won  a  prize  once  without  knowing  I  was  going  to  win  it. 

We  were  skiing  in  Sun  Valley,  Idaho.  One  of  the  things  to  do  there 
is  to  climb  up  to  the  top  of  the  tallest  mountain  nearby.   It  took 
all  day  to  climb  up  there  with  skins.   We  went  into  a  little  cabin 
with  a  wood  stove  and  enough  food  to  last  for  a  couple  of  days. 
The  eggs  froze  in  the  cabin  that  night,  it  was  so  cold  up  there. 


In  front  of  the 
Gerbode  house  at 
Sugar  Bowl  in  the 
Sierra. 


Fishing  with  friend, 
Thomas  Plant. 


307 


Gerbode:   Anyway,  there  was  a  ski  instructor  by  the  name  of  Florian  who 

was  our  guide  to  get  us  up  there.   Florian  the  next  day  after  we 
got  there  did  some  jumping.   He  was  doing  turn-overs  in  the  air 
and  a  lot  of  other  acrobatics.   So  I  took  a  lot  of  pictures  of  him 
doing  it.  We  finally  skied  down  from  the  top  of  this  mountain  after 
a  couple  of  days,  and  I  took  the  film  into  the  photography  shop  in 
Sun  Valley,  and  the  man  who  ran  it  said,  "Why  don't  you  enter  the 
photography  contest?  These  pictures  are  good  enough."   I  said, 
"Fine,  you  make  some  prints  and  put  them  in  it."  We  left  a  couple 
of  days  later,  and  then  I  got  a  letter  from  the  man  saying,  "You 
have  won  the  first  prize  in  the  photography  contest."  So  I  wrote 
back  and  said,  "What  did  I  win?"  He  said,  "You  won  a  dancing 
lesson  with  Arthur  Murray."   [laughter] 

Hughes:   You  have  given  up  photography.   Why  is  that? 

Gerbode:  Well,  I've  never  stopped  taking  pictures,  but  I  gave  up  developing 
them. 


Painting 


Gerbode:   After  I'd  gotten  into  open-heart  surgery — it  was  then  about  1953 — 
I  got  to  know  Hector  Escabosa  quite  well.   He  was  then  manager  of 
I.  Magnin's.   He  and  I  got  along  very  well.   Our  wives  were  very 
compatible,  and  he  for  some  reason  liked  me,  although  my  work  was 
certainly  as  far  removed  from  his  as  you  could  imagine.   He'd  been 
trained  as  an  artist  and  had  started  with  the  Magnin  Company  in 
Seattle  as  a  window  decorator.   Then  finally  he  went  all  the  way  up 
the  ladder  and  became  the  manager  of  I.  Magnin.   He  was  a  very 
lovable,  very  nice,  warm-hearted  person  and  a  good  painter.   So  he 
kept  telling  me  when  I'd  see  him  here  and  there,  "Frank,  have  you 
thought  about  taking  up  painting?"   I  said,  "Well,  I've  thought  about 
it."  He  said,  "I  think  you  could  paint."  So  this  went  on  for  a 
year  or  so.   Finally  he  called  me  up  one  day  and  he  said,  "Frank, 
what  are  you  doing  for  lunch  today?"   I  said,  "Nothing."  He  said, 
"All  right,  I'm  going  to  meet  you  at  Jack's  Restaurant.   We're  going 
to  have  lunch.   Then  we're  going  to  buy  you  some  paints." 

So  we  had  a  martini  lunch  and  a  nice  trne  and  walked  up  to 
Flax's,  which  was  about  four  blocks  away,  and  bought  a  bunch  of 
paints  and  canvases,  and  that  Sunday  we  went  to  his  lovely  apartment 
on  Jackson  Street — it's  a  penthouse  apartment,  a  beautiful  place 
to  paint — and  started  painting. 

Hughes:   He  had  a  real  studio? 


308 


Gerbode:  He  had  a  place  where  you  could  sleep  and  cook,  but  it  was  a  real 

studio  with  a  beautiful  view  of  the  bay.   The  first  thing  I  painted 
was  some  dying  anthuriums.   The  painting  is  now  in  Hawaii.   It's 
not  a  bad  painting. 

So  we  painted  together  about  once  a  week.  Our  wives  would 
come  over  and  give  us  cocktails  once  in  a  while,  and  then  we'd 
have  a  meal  together.   I  didn't  really  take  myself  seriously.   I 
just  was  having  a  good  time. 

The  four  of  us  once  went  to  Hawaii  together  on  a  vacation — this 
was  when  we  first  bought  the  farm  on  Kauai — and  did  some  paintings 
of  the  farm  as  it  was  then.   He  did  some,  and  I  did  some.   We  were 
invited  to  go  to  Jack  Waterhouse's  farm  at  Kipukai  for  a  few  days. 
So  we  took  our  paints  and  stayed  at  Jack's  place  for  about  three 
or  four  days.  He  had  a  Japanese  cook  who  cooked  all  our  meals. 
She  would  come  in  and  say,  "Supper  ready;  you  come  now?"  We  would 
say,  "Well,  just  a  minute,"  and  sometimes  we  would  be  an  hour  later, 
we  were  so  engrossed  in  what  we  were  doing.   I  did  twelve  paintings 
down  there,  some  of  which  I  discarded  or  gave  away,  but  there  are 
two  or  three  that  I  kept  from  that  vacation. 

Hughes:   Were  they  mostly  oils? 

Gerbode:  They  were  all  oils  then.  More  recently  I  switched  to  acrylics. 

We  were  both  members  of  the  Bohemian  Club ,  so  I  began  to  put  a 
painting  into  the  spring  exhibit  of  the  Bohemian  Club  and  also  into 
the  so-called  Ice  House  Show  up  at  the  Grove.   Then  I  guess  about 
twelve  years  ago  I  decided  to  do  a  Christmas  card  every  year.   I 
haven't  done  this  year's  yet,  and  here  it  is  almost  November. 

I've  enjoyed  the  painting,  although  I  don't  take  myself 
seriously.  My  philosophy  is  that  a  painter  should  paint  what  gives 
him  pleasure,  and  if  you  get  to  want  what  somebody  else  wants, 
then  you're  worried  about  that  and  are  not  so  happy. 


Sailing 


Gerbode:   I've  gotten  a  few  other  hobbies  since  then.   So  about  twelve  years 
ago  I  decided — .   I'd  been  looking  at  that  bay  out  there  all  my 
life  and  had  hardly  been  on  it.   I  decided  that  wasn't  right.   If  I 
was  living  by  this  bay  and  I  liked  the  water,  then  I  should  get  a 
boat.   So  I  did  some  research  on  it.  One  day  I  was  in  New  York  during 


A  Farm 


Hrjnk  Cerbode 


Aiguille  tie  Blailirrp  Ohamorux 


Frarw  Gerbode  ;  983 


309 


Gerbode:   the  New  York  Boat  Show,  so  I  went  over  to  the  Boat  Show,  which  is 
one  of  the  biggest  in  the  country.   I  saw  a  boat  which  seemed  to 
fit  what  I  wanted.   So  I  put  a  deposit  on  it  and  I  asked  a  friend 
who  goes  by  the  name  of  Commodore  Warwick  Tompkins,  who  is  one  of 
the  most  famous  sailors  around  the  bay,  if  when  he  was  in  the  East 
he'd  look  at  it  and  see  if  it  would  be  suitable  for  San  Francisco. 
He  did,  so  then  I  bought  it,  and  he  got  it  rigged  for  me.   I 
decided  the  best  way  to  learn  how  to  sail  it  would  be  to  race  it 
and  go  on  as  crew.   Commodore  Tompkins  got  a  very  good  crew  together. 
I  took  the  most  menial  job  on  the  boat  each  time,  but  at  least  I 
learned  how  to  sail  it. 

Hughes:  You  didn't  know  any  of  these  people  beforehand? 

Gerbode:  I  knew  Tompkins  slightly,  but  the  others  not  at  all. 

Hughes:  Was  he  part  of  the  crew? 

Gerbode:  He  was  the  captain. 

ti 

Gerbode:   He's  got  a  tremendous  ego.   If  you  do  something  slightly  wrong,  he'll 
just*  blast  you  openly  on  the  boat.   I  finally  told  him,  "I  can't 
sail  with  you  anymore,  Commodore,  because  you  give  me  an  inferiority 
complex,"  which  is  what  he  always  tried  to  do.   Even  experienced 
sailors  would  [get]  this  treatment.   We  won  a  lot  of  prizes.   I've 
got  a  few  things  at  home.   This  was  the  boat,  that  one  in  the  middle 
there.   [points  to  photograph]   It's  a  thirty-three-foot  sloop. 

Hughes:    It's  a  beauty. 

Gerbode:   It  was  a  very  solid  boat,  not  a  very  powerful  racing  boat,  but  with 
a  good  crew  and  good  sails  and  knowledge  of  how  to  sail  in  the  bay, 
we  managed  to  win  quite  a  few  races.   But  it  was  always  a  chore.   You 
get  the  team  lined  up,  and  then  one  member  might  call  up  and  say, 
"My  wife's  got  a  backache,  I  can't  come."  Then  you  don't  have 
somebody  for  a  key  position  for  the  race,  and  you  have  to  try  to 
find  somebody  else.   It  takes  time,  and  it's  always  a  worry.   I 
always  had  to  bring  the  food  down  for  the  whole  crew  and  arrange 
to  have  everything  fixed  that  got  broken  during  the  race  and  get 
the  boat  cleaned  up.   So  I  finally  gave  up  racing.   I  also  decided 
that  I  wanted  to  get  a  larger  boat. 

[telephone  interruption] 

Gerbode:   I  talked  to  my  friends  here  and  in  the  East  who  were  serious 

sailors,  and  they  said  one  of  the  best  commercially  made  boats  is 
the  Swan  line.   They're  made  in  Finland.   So  I  began  to  get 


310 


Gerbode:   literature  on  it  and  discovered  that  the  boat  I  would  want  is  a 
forty-one-foot  boat,  and  I  finally  order  one.   I  sold  my  Luders 
to  Tom  Plant,  and  I  bought  the  new  Swan,  a  forty-one.   It  came  out 
on  the  top  of  a  Finnish  freighter,  and  it  was  very  dirty  and  had 
been  improperly  mounted  on  the  deck  so  the  company  had  to  spend  a 
lot  of  money  to  get  it  cleaned  up.   It  was  over  there  in  dry  dock 
for  over  a  month,  while  they  cleaned  it  all  up  and  fixed  all  the 
little  things  that  were  damaged  on  the  trip. 

I  sailed  that  Swan  forty-one  for  about  five  years.   Everybody 
who's  got  a  boat  wants  one  smaller  or  bigger.   I  was  staying  with  Tom 
Plant  up  in  the  San  Juan  Islands,  where  he  has  a  beautiful  house. 
We  were  there  one  night  having  dinner ,  and  along  came  a  Swan  about 
the  same  size  as  mine  and  anchored  right  in  front  of  the  house.   So 
we  got  in  a  little  power  boat  and  went  out  to  find  out  who  owned 
this  Swan.   It  proved  to  be  a  dentist  here  in  town.   He  invited  us 
aboard.   He'd  sailed  all  the  way  up  there  with  his  wife  and  newborn 
baby  and  I  think  one  other  crewman.   It  was  quite  apparent  that 
this  boat,  which  was  forty-four  feet  long,  was  much  more  capacrious 
and  much  more  suitable  for  long  cruising  than  my  forty-one.  So  I 
thought,  well,  maybe  I'll  get  one  like  that.   So  when  I  came  back 
I  talked  to  the  Swan  people  here,  and  they  said,  "Well,  we  have 
a  forty-four  in  Annapolis.   We  brought  it  over  to  have  it  shown  at 
the  Annapolis  boat  show,  and  we  were  thinking  of  bringing  it  out 
here  to  show  at  the  boat  show  in  Newport.   We'll  give  you  a  very  good 
price  if  you'll  let  us  show  it  down  south  during  the  fall  boat  show." 
I  said,  "That's  fine."  The  boat  was  at  the  Newport  boat  show  as 
the  queen  of  the  show.   They  got  it  all  dolled  up.   People  had  to 
sign  in  advance  to  go  see  it. 

It's  a  bigger  boat  so  it  takes  more  physical  labor  to 
sail  it.   But  we've  had  a  lot  of  fun  on  it.   I  can  sail  it  with  one 
other  good  sailor.   But  I  usually  like  to  have  two  people  with  me  in 
case  there's  an  accident  of  some  kind,  because  you  at  least  have 
two  people  left  to  do  everything.   It's  very  strong  and  beautifully 
built.   I've  got  four  people  who  have  been  on  the  boat  a  lot.   So 
I  usually  get  one  or  two  of  them  to  come  along,  because  they  know 
what  to  do.   I  don't  really  have  to  do  much  myself,  except  steer  it. 


A  Brush  with  McCarthyism 

Hughes:   Would  you  care  to  tell  the  story  of  your  wife  and  the  problem  with 
the  Communist  affiliation? 


Relaxing  after  the  trans-Pacific  race,  Papaa,  Kauai,  1981. 

Photograph  courtesy  of  Dr.  Ellen  Ki-llebrew 


Sailing  on  San  Francisco  Bay,  early  1980s 


311 


Gerbode:   My  father-in-law  was  a  founder,  with  Ray  Lyman  Wilbur,  of  the 

Japan  Society,  which  later  became  the  Institute  of  Pacific  Relations. 
He  was  very  active  with  Wilbur,  in  improving  our  connections  with 
Japan.   There  were  a  great  many  Japanese  coming  into  the  country  at 
that  time,  and  he  felt  that  Japan  was  close  to  us.   [He  was  also 
interested  in  Japan]  because  of  [his  connections  with]  the  Hawaiian 
Islands,  where  there  were  a  great  many  Japanese  coming  over  as 
laborers.   So  Mr.  Alexander  was  very  keen  on  keeping  good  relations 
with  Japan. 

The  Institute  of  Pacific  Relations  got  to  be  a  little  bigger 
than  just  a  small,  local  organization.   They  opened  an  office  in 
New  York,  mainly  for  fund  raising.   They  put  the  office  in  charge  of 
a  man,  Mr.  Carter,  who  later  became  very  friendly  with  the  Russians. 
I  guess  through  him  the  FBI  began  to  think  that  maybe  it  was  a 
Communist  front  organization. 

Hughes:   When  was  this? 

Gerbode:   This  must  have  been  '38,  '39,  somewhere  in  there.   My  wife  and  I 

didn't  have  much  to  do  with  it.   We  gave  a  small  contribution.   Once 
in  a  while  we'd  go  to  something  that  was  organized  for  the  Japanese, 
usually  in  association  with  diplomats  who  were  sent  over.  Mr. 
Alexander. made  contributions  every  year  because  he  was  a  founder. 

Then  we  began  to  [hear]  that  it  was  being  considered  kind  of 
a  Communist  front  organization  because  of  this  fellow  in  New  York. 
Once  you  get  your  name  down  in  the  FBI  with  anything  like  this, 
you've  had  it.    Some  of  the  people  connected  with  the  organization 
and  some  of  the  neighbors  were  at  a  party  in  Pacific  Heights.   Somehow 
the  FBI  spotted  that  party  as  being  where  the  people  in  the  red  cell , 
so  to  speak,  were  going  to  be  together.   They  catalogued  everybody 
that  went  into  that  place. 

Hughes:   Unbeknownst  to  you  at  the  time. 

Gerbode:   I  was  away  overseas  in  the  war.   They  got  my  wife's  name,  and  also 

that  her  father  was  a  founder  of  the  Institute  of  Pacific  Relations, 
a  principal  backer  and  therefore  suspect.   Meanwhile  she  had  been 
sponsoring  liberal  causes  in  town.   Nothing  Communistic,  but  liberal 
causes,  such  things  as  the  Planned  Parenthood  organization. 

Hughes:    [laughs]   A  well-known  red  front  organization. 

Gerbode:   Right.   She  would  take  public  stands  on  the  liberal  side  once  in 
a  while.   This  was  considered  not  very  good  by  the  FBI  at  that 
point,  because  McCarthy ism  had  started.   Then  anyone  who'd  had  any 
connection  with  anything  that  was  even  slightly  liberal  was  investigated. 


312 


Gerbode:   When  I  got  out  of  the  war  I  was  asked  to  become  a  consultant  for 
the  Veterans'  Administration  Hospital  [in  San  Francisco].  All  of 
a  sudden  the  appointment  was  held  up  and  I  was  investigated  by  the 
FBI.   The  appointment  was  not  granted  because  of  these  [associations 
with  the  Institute  of  Pacific  Relations],   So  I  had  to  hire  legal 
counsel.   I  got  Dick  Guggenheim,  a  friend,  and  Paul  Bissinger,  my 
neighbor,  and  Joe  Moore,  my  friend,  all  good  solid  Republicans 
and  about  as  straight  as  you  could  imagine,  to  testify.   We  had  to 
have  a  hearing  downtown  in  front  of  the  FBI  and  the  Veterans' 
people.   It  was  a  very  sordid  business.   The  sad  part  to  me  was 
that  I  thought  I  had  a  good  war  record.   I'd  been  overseas  and 
gotten  six  battle  stars  and  a  unit  citation  and  a  promotion.   I 
thought  that  was  pretty  good,  enough  to  warrant  being  a  consultant 
for  the  Veterans'.  When  you  sit  down  in  front  of  these  FBI  fellows, 
they  look  at  you  as  though  you  were  a  criminal.   They  can't  tell 
you  anything.   They  can't  sympathize  with  you.   They  just  stare  at 
you  and  ask  more  questions.   It  really  is  the  most  disgusting, 
disheartening  thing  that  you  can  possibly  imagine. 

Finally  that  appointment  went  through,  and  then  I  was  asked  to 
become  a  consultant  to — I've  forgotten  which  position  it  was  in 
Washington.   It  might  have  been  as  a  member  of  the  National 
Research  Council.   That  was  held  up  for  a  long  time.   Finally  the 
Assistant  Secretary  for  Medical  Affairs,  Frank  Berry,  who  had  been 
our  surgical  consultant  in  Europe,  came  to  my  rescue.   He  was  my 
friend  in  Washington.   Once  when  I  was  visiting  him  in  New  York 
at  another  committee  meeting,  I  said,  "Well,  what's  happened  to 
that  position  they  asked  me  to  [take]?"  He  said,  "The  same  old 
business  concerning  the  IPR." 

Hughes:    So  even  though  you  got  the  Veterans'  Administration  appointment — 
Gerbode:   They  had  to  go  through  the  whole  damn  thing  again. 
Hughes:   — it  was  not  taken  off  your  record. 

Gerbode:  Nothing  is  erased  from  your  record.   It  is  impossible  to  get  your 

record  out  of  the  FBI.   I  could  say  you're  a  Communist,  tell  an  FBI 
person  and  cook  up  some  fictitious  [story].   It'll  go  into  your 
record,  and  it'll  stay  there  forever. 

So  I  guess  Frank  Berry  [told]  them  that  I  was  a  good,  law- 
abiding  citizen,  he'd  been  with  me  all  during  the  war,  I  had  a  good 
track  record,  and  everything  was  absolutely  clean.   I  guess  he  got 
it  straightened  out  in  Washington,  because  later  on  I've  been  on 
four  or  five  other  commissions  back  there,  and  that  stuff  has  never 
come  to  the  surface  again.   But  I'll  tell  you,  it's  a  very  sickening 


313 


Gerbode:   thing.   I  never  told  my  wife  during  all  these  investigations  why 
the  FBI  was  investigating  me.   She  knew  something  was  going  on, 
that  I  was  going  down  there,  but  I  never  told  her  a  thing  about 
the  party  she  went  to. 

Hughes:    Because  it  would  upset  her. 

Gerbode:   I  didn't  think  she  had  done  anything  wrong,  and  so  why  bother  her 
with  it. 


314 


IX  TRIPS 

[Interview  13:  April  12,  1984 ]## 

Russia 

Hughes:   Would  you  tell  me  how  your  trips  to  Russia  came  about? 

Gerbode:   The  first  trip  I  made  was  to  a  joint  meeting  of  the  International 
Cardiovascular  and  International  Surgical  Associations  in  Moscow. 
It  was  a  scientific  meeting  with  quite  a  few  participants  from 
other  countries  in  addition  to  Russia.   The  Russians  actually  put  on 
a  very  good  meeting.   They  had  everything  well  organized  and  they 
had  large  meeting  halls.   The  equipment  they  had  to  record  and  to 
hear  the  various  talks  was  beautifully  operated. 

I  would  say  that  the  Russians  did  not  produce  very  much  that 
was  original  or  new.   Most  of  their  papers  were  statistical,  and 
some  of  them  were  even  not  very  good  statistically.   However,  I 
think  the  people  who  went  rather  felt  that  it  was  a  worthwhile 
meeting.   This  lasted  about  five  days  altogether.  We  had  a  very 
good  understanding  for  Russian  medicine  and  Russian  surgery  as  a 
consequence  of  that  meeting. 

Later  on  President  Nixon  went  to  Russia  where  he  was  asked  to 
work  on  a  collaborative  program  with  the  Russians  in  science.   This 
was  a  time  when  he  was  doing  very  well  with  the  Russians,  and  they 
agreed  to  have  a  collaborative  program,  more  or  less  across  the 
board,  in  science.   So  when  he  came  back  they  set  up  committees  in 
various  categories.   For  example,  they  had  a  committee  on  arterio 
sclerosis,  and  one  on  emergency  surgery.  Another  was  on  congenital 
heart  disease.   They  had  people  in  this  country  and  in  Russia  assigned 
to  these  various  committees,  and  they  were  supposed  to  have  joint 
meetings,  have  scientific  presentations,  and  discuss  the  problems 
relative  to  these  various  categories. 


315 


Gerbode:   I  was  appointed  chairman  of  the  committee  on  the  surgical  aspects 

of  congenital  heart  disease.   There  was  a  committee  in  Russia  under 
a  Professor  Boris  Burokovsky  of  the  Bukalev  Institute  in  Moscow, 
which  is  the  biggest  institute  relative  to  heart  surgery  in  Russia. 
I  appointed  a  committee  in  this  country  of  about  five  or  six  members, 
and  Burokovsky  appointed  a  similar  committee  in  Russia  which  was 
supposed  to  work  up  scientific  data  for  presentations. 

Our  committee  then  went  to  Moscow  and  met  with  Burokovsky  at 
the  Bukalev  Institute  and  discussed  what  the  themes  should  be  in 
congenital  heart  disease.   In  other  words,  we  didn't  think  that  we 
should  encompass ; all  the  various  aspects  of  congenital  heart 
disease  because  that  would  be  too  much,  so  we  chose  a  couple  of 
themes  which  might  be  identified  as  subjects  that  could  be  discussed 
bilaterally  between  the  two  countries.   We  set  up  a  time  for  the 
first  meeting.   This  was  set  for  a  year  and  a  half  or  so  after 
this  initial  more  or  less  business  meeting. 

Everything  was  documented  carefully  by  Russian  secretaries,  and 
in  due  time  this  was  all  approved  with  the  official  sanction  of  the 
government.   Then  we  decided  on  a  date.   We  then  went  back  to  Moscow 
and  had  a  joint  meeting  in  one  of  their  big  halls,  and  the 
presentations  were  more  or  less  on  the  subject  matter  which  we  had 
chosen  to  be  important.   There  were  an  equal  number  of  papers  from 
the  Americans  and  from  the  Russians.   These  papers  were  all 
presented  in  an  abbreviated  book. form,  and  th^s  was  distributed  in 
due  time  to  all  the  members  of  the  committees- 

Hughes:   Did  you  find  that  the  congenital  problems  were  similar  in  Russia 
and  the  United  States? 

Gerbode:   I  really  think  the  congenital  problems  are  almost  the  same  worldwide. 
Hughes:   So  it  was  really  obvious  which  ones  needed  attention? 

Gerbode:   Yes,  and  the  terminology  connected  with  each  one  was  pretty  well 
known  between  the  countries.   I  think  you'll  find  the  same 
incidence  of  congenital  heart  disease  in  most  countries.   Some 
countries,  perhaps  Alaska,  among  the  Eskimos,  might  have  more  than 
some  of  the  other  countries,  but  I'm  not  even  sure  of  that. 

The  subject  matter  was  quite  pertinent  and  worthy  of  discussion, 
and  I  think  the  presentations  were  generally  quite  good.   However, 
I  think  the  American  presentations  were,  if  I  may  say  so,  much  more 
advanced  and  new  than  the  Russians'.   The  Russians,  I  thought 
generally  speaking,  were  playing  catch  up,  if  you  can  use  that  term. 


316 


Gerbode:   Obviously  they  were  behind  in  technology  in  developing  methods  of 
treating  congenital  heart  disease  and  therefore  their  results 
were  not  quite  as  good. 

However,  the  participants  got  along  fairly  well.   The  social 
programs  arranged  by  the  Russians  for  the  Americans  were  quite  good. 
They  took  us  to  a  number  of  dinners  and  luncheons  and  that  sort  of 
thing.   Lots  of  drink.  Lots  of  vodka.   And  lots  of  toasts. 

Hughes:   When  you  say  that  they  are  behind  in  medical  technology,  does  that 
imply  that  they're  not  keeping  up  with  the  world  literature? 

Gerbode:  Well,  they,  for  example,  had  to  make  their  own  heart-lung  machine, 
which  was  not  very  good,  being  a  copy  of  an  American  heart-lung 
machine.   Their  respirators  were  mostly  not  Russian  respirators; 
they  were  copies  of  Western  respirators.   One  was  made  in  East 
Germany.   Some  were  made  locally  in  Russia,  but  were  not  very 
satisfactory.   Their  intensive  care  unit,  where  the  seriously  ill 
patients  were  taken  care  of ,  was  about  ten  years  behind  our  level 
of  competence.   They  had  decided  some  years  before  we  went  there 
that  monitoring  of  patients  requiring  intensive  care  was  important, 
so  they  had  bought  a  very  big  console  from  Italy  to  monitor  various 
parameters  in  these  sick  people,  but  they  could  never  make  it 
work.   It  was  sitting  there  like  a  white  elephant  in°  their  intensive 
care  unit,  which  means  that  then  they  were  obliged  to  measure  very 
simple  things  with  rather  out-of-date  methods. 

Hughes:   Why  do  they  put  up  with  inferior  technology? 

Gerbode:   I  don't  think  their  industries  were  advanced  enough  to  do  it.   For 
example,  just  the  matter  of  tubing.   They  didn't  have  enough  tubing 
to  use  disposable  plastic  tubing  for  every  case.   So  then  they  used 
rubber  tubing,  which  they  then  cleaned  and  sterilized  and  reused, 
which  is  a  very  primitive  way  of  doing  it,  because  you  can't  really 
clean  rubber  tubing  once  you  use  it  and  people  get  febrile  reactions 
and  other  things  from  it.   There's  one  thing  in  its  favor  and  that 
is  it ' s  cheap  if  you  use  it  over  and  over  again ,  but  cheap  at  the 
expense  of  the  patient. 

They  had  made  a  ball  valve,  for  example,  which  was  a  copy  of 
our  Starr-Edwards  ball  valve,  not  very  satisfactory. 

Hughes:   What  is  to  prevent  them  from  buying  a  heart-lung  machine,  for 
example,  from  the  West? 

Gerbode:  Well,  they  started  doing  that;  they  finally  bought  a  monitoring 

system  from  Hewlett-Packard.   It  was  a  long  time  being  delivered, 
and  they  kept  writing  letters  to  me  and  telephoning  to  see  if  I 


317 


Gerbode:   could  get  the  delivery  time  speeded  up  a  bit.   Hewlett-Packard 

kept  telling  me  that  it  was  being  made  for  them  by  an  Eastern 
factory  of  Hewlett-Packard.   Eventually  they  got  it,  and  I  think 
it's  working  all  right. 

Hughes:    But  that  is  an  option  for  the  Russians. 

Gerbode:   It  was  an  option,  yes,  but  it  wasn't  in  the  very  beginning.   In 

the  very  beginning  I  think  they  rather  felt  they  could  do  all  these 
things  themselves,  but  then  they  couldn't.   The  same  thing  is 
happening  with  the  Chinese.   The  Chinese  don't  have  the  money, 
which  is  one  big  difference,  but  they  know  what  they  should  have 
and  they  try  to  make  it.   They've  done  a  fair  job  of  copying  Western 
devices. 

Hughes:   Are  you  saying  that  the  Russians  do  have  the  money? 

Gerbode:   Oh,  they  certainly  have  enough  to  put  a  person  into  space.   That's 
millions  of  dollars. 

Hughes:    But  it's  a  question  of  whether  the  government  would  allow  that  kind 
of  money  to  be  used  for  [medicine] . 

Gerbode:   It's  a  matter  of  priority,  sure.   I'm  sure  if  they  felt  that  medicine 
and  medical  devices  were  a  high  priority  they  could  do  a  lot  better 
than  they're  doing. 

Hughes:    How  much  do  they  rely  on  developments  in  the  rest  of  the  world? 

Gerbode:   I  would  say  that  the  answer  to  that  is  how  much  original  work  comes 
out  of  Russia — very  little.   I  think  the  best  thing  they  ever  did  in 
recent  times  was  to  develop  stapling  machines  to  make  intestinal 
anastomoses.   It  didn't  take  very  long  for  American  companies  to 
meet  that  challenge  and  produce  their  own  instruments,  which  are 
quite  good,  maybe  even  better  than  the  Russians,  I  don't  know.   But 
that  was  one  thing  the  Russians  did  originally  which  was  innovative 
and  quite  good. 

Hughes:    Can  you  explain  why  there  is  so  little  innovation  in  a  country  the 
size  of  Russia? 

Gerbode:   Oh,  I  think  it's  just  a  matter  of  the  emphasis  being  placed  on  the 
people  that  have  ability.   If  you  follow  people's  real  ability,  you 
can  make  things  for  space,  or  automobiles,  or  whatever.   Priority 
is  established  from  above. 


318 


Hughes:   You  said  that  you  got  an  understanding  for  Russian  medicine  and 
surgery.  Was  that  because  you  were  actually  taken  around  to 
different  hospitals? 

Gerbode:  Yes.   They  had  meetings  and  presentations  in  hospitals,  and  they 
produced  their  best  figures  and  their  best  case  reports.   They 
tried  very  hard  to  put  their  best  foot  forward.   One  of  the 
principal  problems  of  the  Russians  is  they  never  admit  that  they're 
not  first-class  in  any  category.   If  they  did,  they'd  probably  have 
their  heads  cut  off  as  individuals.   If  you  ask  them  if  they've 
ever  done  a  certain  thing,  they'll  say,  "Oh  yes,  we've  done  that. 
We  did  it  years  ago,"  or  "We've  done  that  a  thousand  times."  They 
cannot  say  they  never  did  it.   And  it  isn't  that  they  don't  want  to 
as  individuals;  it's  because  they  don't  dare  say  what  is  really 
true,  which  means  that  present  Russians  cannot  be  intellectually 
honest.   That's  the  biggest  deficiency  I  think  our  people  have  found 
with  them,  that  they  are  not  intellectually  honest.  And  they  can't 
afford  to  be  as  individuals.   It's  sad. 

The  Chinese,  on  the  other  hand,  are  mainly  very  intellectually 
honest.   If  they  haven't  done  it,  they'll  tell  you,  or  if  they've 
done  it  twice,  they'll  tell  you.   They  try  very  hard  to  make  their 
own  instruments  when  they  can't  buy  them.  And  they'll  apologize  for 
having  tried  and  not  having  done  a  very  great  job,  but  they  made 
their  best  effort. 

Hughes:   Did  you  get  a  feeling  about  how  successful  the  Russian  medical 
system  is  in  caring  for  an  average  patient? 

Gerbode:   It's  pretty  hard  to  find  out  about  that,  because  you  don't  have  any  real 
figures  on  it.   From  what  I  could  gather,  they're  doing  very  well 
with  emergency  services.   Their  ambulance  services  in  the  big  cities 
I  think  are  quite  good  from  what  I  could  gather,  and  getting  people 
quickly  to  the  right  hospital  with  emergency  ailments. 

Hughes:   Is  their  system  of  training  and  qualification  similar  to  ours? 

Gerbode:  Much,  I  think,  depends  on  whether  somebody  under  whom  you're  working 
likes  you  and  whether  you're  a  good  member  of  the  party. 

Hughes:   So  politics  does  play  a — 

Gerbode:  Politics  is  terribly  important.   Nobody  coming  up  this  ladder  will 
ever  say  anything  bad  about  anything  in  the  system,  even  their  own 
unit.   They  can't  afford  to.   So  self-criticism  in  the  sense  that  we 
know  it  in  this  country  or  in  England,  let's  say,  just  can't  exist, 
and  it  can't  exist  because  it's  not  practical. 


319 


Hughes:    I  know  in  China  there's  a  subcategory,  if  you  can  call  it  that,  of 
the  barefoot  physician;  is  there  anything  comparable  in  Russia? 

Gerbode:   No,  I  don't  think  so.   They  sort  of  categorize  the  female  doctors  in 
this  category.   But  I  saw  some  very  good  female  doctors  when  I  was 
there.   One  of  the  best  heart  surgeons  they  have  is  a  female. 

Hughes:   Are  women  more  highly  represented  in  the  system  than  they  are  in 
this  country? 

Gerbode:   It's  very  hard  to  find  a  female  surgeon  at  all  in  this  country.   But 
they  do  accept  them  there,  because  it's  a  matter  of  work,  and  if  they 
can  do  the  work,  they  let  them  do  it. 

Hughes:   Why  were  you  appointed  chairman  of  the  committee  on  congenital 
anomalies? 

Gerbode:   I  don't  know.   You  never  know  where  these  things  originate.   Maybe 
it  was  because  I  had  done  so  many  open  heart  cases  early  on  in 
congenital  heart  disease.   I've  written  a  certain  number  of  papers. 

Hughes:   What  was  the  national  umbrella  under  which  this  committee  fell? 

Gerbode:   It  was  something  like  National  Cooperative  Effort  or  Association 
with  Russi.i  in  Scientific  Matters. 

Hughes:   It  was  an  entity  unto  itself. 

Gerbode:   Yes,  it  had  a  budget  established  by  Congress  and  run  by  a  committee 
in  Washington. 

Hughes:    It  met  only  one  time? 

Gerbode:   No.   I  was  going  to  say  that  the  next  meeting  was  held  in  Washington 
at  NIH.   We  again  prepared  papers.   We  selected  some  more  Americans 
who  hadn't  been  to  Russia  before  but  who  had  important  things  to 
describe  or  talk  about,  and  they  presented  their  papers,  and  the 
Russians  tried  to  do  the  same.   But  actually,  by  the  second  meeting 
it  was  quite  apparent  that  they  were  having  difficulty  finding 
really  good  things  to  talk  about ,  whereas  we  had  some  pretty  good 
stellar  performers  to  talk  about  their  work.   Anyway,  it  was  very 
amicable,  and  we  had  nice  luncheons  and  dinners  in  Washington  for 
about  three  days  and  decided  that  the  next  meeting  again  would  be 
in  Russia. 


320 


Gerbode:   So  we  all  went  back  again.  At  that  point  I  decided  that  I  would 
rather  not  be  chairman  of  the  committee  any  longer ,  because  I  had 
other  things  to  do,  and  I  felt  that  I'd  made  my  major  accomplishment 
by  getting  it  going.   So  I  turned  the  chairmanship  over  to  Henry 
Bahnson,  who  is  professor  of  surgery  at  the  University  of  Pittsburgh. 

Hughes:   Was  that  your  decision  to  pick  him? 

Gerbode:  Yes,  they  accepted  my  recommendation  and  Henry  was  made  chairman  of 
the  committee.   I  participated  in  the  committee  for  one  year  after 
that. 

Hughes:   What  responsibilities  does  the  chairman  have? 

Gerbode:  The  chairman  has  to  get  people  to  present  their  best  work  from  this 
country  and  to  get  them  to  go  to  Russia  or  present  the  material  in 
Washington . 

Hughes:    [The  chairman]  actually  chooses  the  individuals? 

Gerbode:  Yes,  I  think  I  originally  picked  out  ten  people.   Then  the  second 

time  around  we  used  some  of  the  old  ones  and  some  new  ones ,  and  then 
Bahnson  had  to  pick  the -ones  for  the  next  go-around. 

Hughes:   Where  was  the  money  coming  from  for  these  trips? 

Gerbode:   It  all  came  out  of  an  allocation  from  Congress,  a  budget  developed 
for  the  effort.  We  have  a  budget  like  that  with  the  Chinese  at  the 
present  time,  too. 

Hughes:   But  nothing  with  Russia  anymore? 

Gerbode:   I  think  the  committee  is  still  operating,  but  I'm  not  sure  when  the 
next  meeting  is  going  to  be. 

Hughes:   So  it  is  an  ongoing  thing. 

Gerbode:   To  a  certain  extent  it's  ongoing.  When  you  talk  to  the  chairmen  of 
other  committees,  the  overall  result  has  been  that  the  Russians 
probably  got  a  lot  of  information  from  us,  and  we  got  practically 
nothing  from  them.   It  wasn't  that  they  were  holding  anything  back; 
it  was  just  because  they  didn't  have  too  much  to  offer  that  was 
really  first-class.  The  people  involved  are  very  likable. 

Burokovsky  is  a  very  likable,  stout  man.   His  daughter  was  in 
terrible  trouble  from  a  simple  operation.   I  think  it  was  something 
like  an  ovariectomy.   The  anesthetic  was  not  very  good  so  she  had 


321 


Gerbode:   cardiac  arrest,  and  then  she  got  pulmonary  complications  of 

resuscitation.   There  were  several  long  distance  calls,  of  which  I 
got  one:   "Should  we  do  this  or  do  that  for  her?"  Finally  we 
settled  on  sending  a  young  fellow  from  Boston  to  go  over  and  help 
out  the  situation.   I'm  merely  saying  that  this  is  an  example  of 
their  realizing  at  high  level  that  something  special  was  needed,  but 
they  were  not  able  to  do  it  locally. 

Hughes:   Do  they  read  the  world  literature? 

Gerbode:   Yes,  they  have  all  the  literature.   There's  no  question  about  that. 

Hughes:   Does  the  average  physician  speak  or  read  English? 

Gerbode:   No.   Most  of  the  people  in  the  big  centers  speak  and  read  enough 
English  to  get  by.   But  it  doesn't  go  very  far  in  depth. 

Hughes:    But  enough  so  that  they  can  read  the  English  literature? 

Gerbode:   Yes.   There  were  a  few  of  the  Russians  whom  we  met  who  were  fairly 
outspoken  about  the  system.   I  don't  wish  to  mention  their  names 
because  somebody  may  read  about  them  and  they  might  get  in  trouble. 

Hughes:   What  sort  of  things  were  they  saying? 

Gerbode:   They  were  having  trouble  getting  proper  equipment,  proper  things 

for  their  patients.   One  of  the  professors  had  a  daughter,  and  she 
got  to  like  an  English  correspondent.   I  don't  know  if  anything  was 
present  more  than  like,  but  they  got  to  the  point  .of  wanting  to 
correspond ,  and  all  of  a  sudden  the  letters  were  terminated  by  the 
postal  service. 

Hughes:   Would  you  say  that  the  Russian  physician  has  a  similar  position  in 
society  that  the  American  does? 

Gerbode:   No,  I  wouldn't  think  so.   I  think  the  people  in  society  who  are  in 
the  driver's  seat  are  the  members  of  the  Communist  party  who  have 
official  appointments.   Burokovsky,  who  was  the  professor  of  the 
biggest  heart  unit  in  all  of  Russia,  lived  in  a  small  apartment  with 
two  bedrooms,  very  meagre  furnishings,  a  rickety  old  elevator. 

Hughes:   Was  he  on  a  salary? 

Gerbode:   Oh  sure. 

Hughes:   There  is  nothing  approaching  private  medicine? 


322 


Gerbode:   Oh  no,  nothing  at  all.   I  suppose  somebody  who's  a  farmer  or  something 
like  that  might  bring  in  a  goose  or  something  and  give  it  to  the 
professor.   [laughs] 

I've  been  on  the  list  to  help  with  Russian  committees  in 
medicine  who  come  to  San  Francisco,  because  I've  been  identified 
with  these  committees  I've  been  on.   They  very  often  call  me  when 
one  of  these  delegations  comes  here,  and  I  give  them  a  cocktail 
party  or  supper  or  something. 

I'll  tell  you  something  that  probably  shouldn't  be  in  the  record, 
but  one  of  the  last  delegations  which  came  through  last  year  was  a 
group  of  specialists,  and  the  chief  of  pathology  for  all  of  Moscow 
was  in  the  delegation.   The  delegation  otherwise  was  led  by  a 
professor  of  surgery  in  Moscow  who's  a  terribly  nice  fellow,  very 
polite,  has  good  manners,  and  gets  along  very  well  with  the  Americans. 
I  like  him  very  much.  Anyway,  the  group  came  here.   I  had  some 
hors  d'oeuvres  and  a  buffet  supper  lined  up  for  them.   The  hor  d'oeuvres 
vanished  in  about  two  seconds.  Then  I  noticed  that  the  professor  of 
pathology,  head  of  all  the  pathologists  in  Moscow,  had  disappeared, 
and  I  looked  around  and  I  couldn't  see  him.   So  I  finally  came  to 
the  library,  and  he  was  sitting  on  a  stool  in  front  of  the  fireplace, 
smoking  and  blowing  the  smoke  up  the  chimney  because  somebody  told 
him  I  didn't  like  people  to  smoke  in  my  house.   [laughter]  And  he 
did  the  same  thing  after  the  buffet  supper  was  finished. 

Well,  there's  another  great  difference  between  the  Chinese  and 
the  Russians.   The  Chinese  are  born  with  good  manners.  They  know  what 
to  say  and  what  to  do  and  how  to  act  naturally.   The  Russians  never 
do.   You  have  a  feeling  that  everything  they  do  and  say  is  more  or 
less  drilled  into  them,  and  you're  never  quite  sure  what  they  really 
think  or  believe.   The  Chinese  are  just  the  opposite.  What  they  say 
is  usually  quite  honest  and  very  straightforward. 

Hughes:   Do  you  think  this  is  anything  to  do  with  the  political  situation? 

Gerbode:   I  think  they're  born  that  way.   I  don't  know  how  you  get  that 

developed  into  a  gene.   There's  a  big  difference  in  dealing  with 
people. 

Hughes:   It  sounds  as  though  you  couldn't  have  a  very  intimate  conversation 
with  a  Russian. 

Gerbode:   Oh,  never.   Particularly  if  they  don't  have  good  manners  and  they're 
not  intellectually  honest,  then  you  can't  ever  have  a  really  decent 
conversation,  because  sooner  or  later  you  make  a  remark  about  something 
over  which  there's  a  slight  controversy,  and  then  they  will  always 


323 


Gerbode:   avoid  any  personal  statement  about  it,  and  they'll  say  only  what 

is  generally  accepted.   Otherwise  you  deal  entirely  with  platitudes— 
the  weather,  the  country,  simple  things  that  everybody  will  accept 
as  being  reasonable  discussions.   You  don't  discuss  sex  or  crime  or 
alcoholism  or  robberies. 

Hughes:   Or  politics. 

Gerbode:   Or  politics  above  all.   Oh,  they're  interested  in  our  country.   They 
ask  you  questions  about  our  country,  but  they  would  never  have  an 
opinion  themselves. 


China 


Hughes: 
Gerbode: 


Gerbode; 


Tell  me  the  circumstances  of  the  two  visits  to  China. 

Professor  Y.  K.  Wu  is  a  charming  man  whom  I  met  before  the  revolution 
when  I  was  a  resident  in  surgery  at  Stanford.   He  liked  me.   He  came 
over  from  the  Rockefeller  Institute  in  Peking  to  have  a  tour  of  the 
country  and  to  work  with  Evarts  Graham  in  St.  Louis  for  a  while. 
Afterwards  he  went  back  to  Peking  and  became  the  first  trained 
thoracic  surgeon  in  all  of  China,  did  the  first  big  operations,  and 
became  a  leader  in  the  field  as  chief  of,  I  guess,  thoracic  surgery 
at  Peking  Union  Medical  College.   Then  the  Chinese  revolution  came 
along,  and  since  he  was  an  intellectual  and  since  they  terminated 
all  teaching  in  China,  he  was  shipped  off  to  the  country  to  be  an 
ordinary  dirt  farmer.   He  had  a  little  house  in  Peking — I  think  he 
had  two  children  and  his  wife — the  government  simply  took  half  of  it 
away  and  gave  it  to  somebody  else.   So  his  family  had  to  share  the 
house  with  an  unknown  family,  while  he  was  off  being  a  farmer  in  the 
country.   Luckily,  he  wasn't  killed.   A  lot  of  the  intellectuals  were 
killed  by  the  Chinese  at  that  time. 


In  any  event,  after  the  revolution  was  over,  he  was  reinstated. 


## 


It's  not  the  old  Peking  Union  Medical  College;  they  never  restored 
that  to  what  it  was  before,  because  that  was  completely  American  in 
conception  and  financing  by  the  Rockefeller  family  and  the  Rockefeller 
Foundation. 


Hughes:   Was  that  pride  that  they  didn't  reinstate  it? 


324 


Gerbode:   I  suppose  so.   In  any  event,  it's  now  called  the  Capital  Hospital 

and  has  its  own  budget  from  the  Chinese  government.   Y.  K.  Wu  began 
to  develop  his  former  friendships  in  this  country  and  got  enough 
money  to  travel  around  and  meet  some  of  the  people  he  had  known 
when  he  was  in  the  old  teaching  university  there,  and  began  to 
develop  a  program  of  cardiac  surgery,  as  well  as  pulmonary  surgery. 
He  arranged  to  have  some  of  his  young  people  sent  around  to  clinics 
here  and  there  in  this  country  for  training,  to  be  brought  back 
and  then  put  into  good  hospitals  in  China.   His  program  is  still 
going,  but  unfortunately  now  our  government  has  stopped  us  from 
giving  any  foreign  doctors  any  clinical  responsibility,  and  there's 
virtually  no  money  from  them  either. 

Hughes:  Who  was  responsible  for  instituting  that  policy? 
Gerbode:  That's  a  policy  of  the  United  States  government. 
Hughes:  Dating  from  when? 

Gerbode:  About  three  years  ago  [1981].   So  this  terminated  all  the  foreign 

fellowships.   I  had  all  my  foreign  fellowships  terminated  then,  too. 

Hughes:   Was  that  fear  of  competition? 

Gerbode:   I  think  mainly  it  was  because  so  many  people  came  from  underprivileged 
third  world  countries  and  wouldn't  go  home.   South  America  is  a 
prime  example  where  hundreds  of  men  came  up  here  after  they  finished 
their  medical  school,  went  into  training  programs,  and  then  just 
didn't  want  to  go  home  anymore. 

Hughes:   Did  the  AMA  have  a  role  in  this? 

Gerbode:   The  AMA  took  a  position,  I  think,  of  believing  that  the  programs 

should  be  curtailed.   So  anyway,  it  was  very  difficult  to  have  the 
Chinese  come  over  here,  and  it's  still  difficult,  except  if  they 
come  over  and  simply  are  observers.   If  somebody  can  pay  for  them, 
they  can  come  if  the  chief  will  let  them  come,  and  they'll  observe. 
For  example ,  last  year  six  Chinese  from  a  whole  team  in  Peking  were 
sent  over  and  they  observed  for  a  year  at  the  Pacific  Medical 
Center.   But  that's  very  difficult,  too,  because  if  you  can't 
really  let  them  do  things  or  be  responsible  for  patient  care,  all 
they  can  do  is  watch  and  guess  what's  right.   But  it's  not  the  full 
way  to  train  anybody. 

Hughes:   Obviously  this  policy  hurts  the  rest  of  the  world;  but  doesn't  it 
also  have  repercussions  for  this  country? 


325 


Gerbode:   Well,  it  does  certainly — the  world  has  been  saturated  with  graduates 
of  our  training  programs.   Now  there  are  so  few  of  them  here.   Many 
of  them,  I  think,  are  going  to  England,  where  it's  become 
difficult  too,  or  Germany,  where  it's  also  very  difficult.   It's 
now  much  harder  for  a  foreign  graduate  to  get  into  any  kind  of  a 
training  program  outside  of  his  own  country. 

Hughes:   What  would  a  young  Chinese  with  ambitions  in  surgery  do? 

Gerbode:   About  the  only  thing  he  can  do  is  get  a  traveling  fellowship,  either 
from  somebody  in  this  country  or  through  our  China  committee.   There 
is  a  committee  set  up  in  Washington  with  federal  funds,  a  cooperative 
committee  very  much  similar  to  the  Russian  one,  where  people  are 
selected  to  come  if  they  have  a  place  to  go  back  to  and  if  the 
Chinese  will  pay  for  part  of  their  experience  in  this  country  and 
if  somebody  will  accept  them.   But  when  they  get  here,  all  they 
can  do  is  observe,  go  to  rounds  and  watch  operations. 

Hughes:   Would  their  preference  in  general  be  to  come  to  this  country,  rather 
than  Britain,  for  example? 

Gerbode:   Yes,  I  think  so.   We're  still  the  predominant  country,  although 
there  are  quite  a  few  going  to  England  and  some  to  Germany  and 
Scandinavia,  too. 

Hughes:   Did  you  get  any  impression  of  how  much  influence  traditional 
Chinese  medicine  still  has  on  everyday  practice? 

Gerbode:   Well,  that's  a  very  curious  thing,  if  you're  talking  about  acupuncture 
and  herb  medicine. 

Hughes:   Yes. 

Gerbode:   All  the  villages  have  a  traditional  Chinese  medicine  department,  and 
it  looks  like  some  of  the  stores  we  have  downtown  in  Chinatown 
with  all  these  herbs  and  bottles  around.  A  traditional  Chinese 
doctor  will  write  out  a  prescription  of  herbs  for  a  given  patient. 
They  mix  it  up  just  like  we  mix  up  a  prescription  in  our  drugstore, 
and  the  patient  drops  by  to  take  it. 

Now,  why  do  they  retain  these  things,  particularly  acupuncture? 
You  go  into  the  hospital  and  they  have  a  section  devoted  to  taking 
care  of  patients  with  acupuncture.   Which  operations  do  they  do 
under  acupuncture?  Once  in  a  while  they  can  get  a  patient 
psychologically  prepared  to,  let  us  say,  have  an  atrial  septal  defect 
or  something  relatively  simply  done  with  acupuncture,  but  that 
patient  has  been  verbally  trained  to  accept  acupuncture,  and  also  he's 


326 


Gerbode:   under  a  fair  amount  of  intravenous  medication,  like  morphine  or 

demerol.   So  it  is  well  known  among  cardiac  surgeons,  for  example, 
that  you  can  do  lots  of  operations  with  intravenous  demerol  and 
oxygen.   In  fact,  I  wrote  a  paper  on  it  once.   I  did  about  two 
hundred  cases  that  way. 

Hughes:   With  the  patient  ostensibly  conscious? 

Gerbode:  Well,  he's  half  conscious,  but  he  can't  feel  anything  because  the 
intravenous  demerol  knocks  out  his  pain  centers. 

Hughes:   And  do  the  Chinese  use  demerol? 

Gerbode:  You  never  know  how  much,  but  they  do  use  intravenous  medication.   So 
if  you  ask  one  of  the  higher  authorities  in  any  one  of  these  big 
clinics,  they'll  say,  "Well,  about  the  only  time  we  use  acupuncture 
these  days  is  for  head  and  neck  surgery."  For  some  reason  it  works 
a  little  better  to  use  it  for  operation  above  the  clavicle.   I  don't 
know  for  sure  what  the  reasons  for  that  are,  but  that's  what  is  true. 
Also,  the  other  thing  that's  true  is  they  always  had  an  anesthesiologist 
on  standby. 

Now,  the  other  reason  for  maintaining  traditional  Chinese 
medicine  is  that  the  Chinese  politicians  believe  that  it's  still  very 
good  treatment,  and  probably  some  of  it  is. 

Hughes:   It's  probably  politically  expedient,  too. 

Gerbode:   That's  the  whole  point.   They  don't  dare  say  that  Western  medicine 
is  better.   So  in  every  one  of  these  big  centers  they  have  a 
section  on  traditional  Chinese  medicine  supported  by  a  federal 
budget,  and  also  they  send  people  to  this  country  as  missionaries 
of  traditional  Chinese  medicine  who  are  trying  to  convince  the  outer 
world  that  it's  still  good.   I've  had  some  come  to  me  in  my  house. 
I  had  one  of  them  give  a  lecture  here  once.  Not  very  convincing,  but 
at  least  on  record  when  he  went  back  home  he  could  say  he  gave 
lectures  on  it  here,  there  and  elsewhere. 

I'm  probably  talking  it  down  a  little  bit  more  than  I  should, 
but  the  Western-trained  people  who've  been  here  and  in  England, 
Germany,  and  Scandinavia,  don't  use  it  except  maybe  occasionally  for 
political  reasons.  Now,  in  the  country  I  guess  it's  a  way  of 
giving  [patients]  what  almost  amounts  to  a  placebo,  by  giving  them 
some  herbs  to  make  them  be  sure  that  they're  being  taken  care  of — 
until  the  point  that  they  have  a  tumor,  then  obviously  they'll 
take  care  of  it  another  way. 


327 


Hughes:  Is  there  a  formal  system  of  education  for  the  traditional  medicine? 

Gerbode:  I  think  so.   They  have  courses. 

Hughes:  But  it's  not  a  four-year  medical  school. 

Gerbode:  No,  I  think  it's  mainly  courses  within  their  normal  curriculum. 

Hughes:  There  were  two  trips  to  China? 

Gerbode:   The  first  trip  was  organized  by  Y.  K.  Wu.   He  had  one  American,  one 
Frenchman,  one  Swiss,  one  Englishman,  and  one  Romanian.   Y.  K.  had 
enough  political  power  to  say,  "I  would  like  to  have  these  people 
come  over  and  talk  on  various  aspects  of  medicine."  He  asked  me  to 
talk  on  a  certain  part  of  cardiac  surgery,  and  he  asked  the  other 
ones  to  discuss  something  that  they'd  been  particularly  interested 
in.   Our  main  meeting  was  in  a  relatively  small  town,  Hanchan,  and 
this  was  the  first  meeting  of  the  Chinese  Medical  Association  in 
fifteen  years. 

Hughes:   Why  was  that? 

Gerbode:   Well,  because  of  the  revolution.   They  asked  me  to  give  the  opening 
introduction,  the  good  words,  which  I  managed  to  put  together 
properly.   But  to  look  at  the  mass  of  about  two  thousand  physicians, 
all  in  the  same  gray  coats,  in  this  big  hall,  was  really  something, 
and  to  know  that  this  was  the  first  time  they'd  had  a  formal  meeting 
in  fifteen  years.   They  housed  them  in  various  buildings  all  around 
the  town  and  fed  them  in  big  halls. 

We  put  on  a  program  of  emergency  surgery,  cardiac  surgery,  and 
coronary  surgery. 

Hughes:   Did  you  have  the  feeling  that  you  were  telling  them  things  that  they 
hadn't  heard  before? 

Gerbode:   Yes.   I'm  sure  they  hadn't  been  able  to  read  the  literature  on  all 
these  subjects. 

Hughes:   What  about  their  ties  to  Russian  medicine? 

Gerbode:   That  had  terminated  abruptly  a  year  before,  although  in  some  of  the 
hotels  they  still  had,  for  example,  "restaurant"  listed  in  English, 
and  then  before  that  on  the  same  strip  was  "restaurant"  written  in 
Russian,  so  you  knew  that  they  had  been  around  most  places.   But  by 
the  time  we  got  there  no  one  hardly  even  mentioned  the  word  Russian. 


328 


Gerbode:  They  took  very  good  care  of  us.   We  stayed  in  an  old  hotel  which 

had  been  built  by  the  French  many  years  before.   It  was  quite  old- 
fashioned.  We  had  hot  water.   They  brought  us  tea  to  the  room  in 
the  morning.   We  had  rather  standard  meals  in  a  big  hall.   Coffee 
was  very  difficult  to  get  in  any  quantity  or  quality. 

For  the  first  meeting  to  Russia,  for  example,  my  English 
friend,  whose  name  I  won't  mention,  said,  "Frank,  you  know,  the 
Russians  have  finally  learned  how  to  make  coffee  out  of  grounds." 
Which  is  a  typical  English  remark.   In  Russia  they'd  serve  you  an 
egg  or  a  piece  of  bread  or  toast  or  something,  and  then  after  you'd 
finished  all  of  that  they'd  bring  in  this  terrible  coffee. 

Hughes:   Do  you  care  to  say  anything  more  about  the  China  trip? 

Gerbode:  Yes,  I  would  like  to  say  that  the  first  trip  impressed  me  with  how 
friendly  and  honest  they  were.  We  never  locked  anything.   The 
regional  Communist  officials,  the  men  who  are  really  in  charge  of 
the  Communist  party,  came  to  a  dinner  party.   They  were  very 
friendly.   It  was  difficult  to  communicate  with  them  because  they 
couldn't  speak  English,  but  they  had  interpreters  there.   Everything 
we  said  on  the  stage  at  those  meetings  was  translated  right  away. 
They  put  on  a  Chinese  opera  for  us.  They  took  us  to  the  theater 
where  acrobatics  were  being  put  on,  which  was  fantastic. 

I  took  a  long  train  trip  from  Shanghai  to  Peking,  which  is 
really  something.   I  had  to  share  a  compartment  with  Y.  K.  Wu.   It 
was  really  kind  of  an  uncomfortable  trip.   The  sanitation  facilities 
on  those  trains  were  just  like  the  Russian  or  the  old  French.   Nobody 
seemed  to  clean  them  up. 

Anyway,  we  got  to  Peking  and  we  were  put  in  a  very  nice,  modern 
hotel  in  Peking,  which  was  filled  with  business  people — Americans, 
English,  Europeans.   They  took  us  to  the  famous  Peking  Duck  Restaurant 
for  a  big  feast  and  to  a  symphony  concert  in  a  great  hall.   I  think 
that  hall  held  something  like  six  thousand  people.   Then  we  went  to 
the  Great  Wall  in  private  cars.   They  just  treated  us  very  beautifully. 
The  meals  were  interesting.   Breakfast  was  certainly  much  better  than 
the  Russian  breakfast.   They  had  coffee  and  tea  and  beer  at  every 
meal.   Pretty  good  beer. 

Hughes:   Breakfast? 

Gerbode:  Yes.  They  had  eggs  and  cereal  and  rice  for  breakfast.   What  you 
miss  in  all  these  countries,  Russia  as  well  as  China,  is  fresh 
green  vegetables.  And  the  only  things  we  really  got  in  China  were 
green  beans,  but  no  lettuce.   Once  in  a  while  some  tomatoes  or 


329 


Gerbode:   cucumbers.   Cucumbers  seemed  to  be  generally  [available]  in  Russia 
and  China,  mainly  Russia — I  guess  the  cucumber  lasts  a  long  time, 
and  you  can  ship  it  around  and  nothing  much  happens  to  it.   And 
they're  easy  to  grow. 

They  took  us  to  Canton,  where  we  saw  the  great  trade  building 
where  all  their  Chinese  goods  are  on  display  for  foreign  buyers. 
Rugs  and  silks  and  even  tractors  and  automobiles.   They're  about 
twenty  years  older  than  our  vintage ,  but  they  looked  reasonable 
well  made. 

Hughes:   And  a  lot  of  foreigners  looking  at  them? 

Gerbode:   Yes.   Well,  they're  really  there  to  buy,  I  guess,  silks  and  rugs 
and  things  like  that.   This  rug  [in  my  library]  came  from  Peking, 
for  example,  not  from  the  Canton  trade  fair,  but  from  the  so-called 
Friendship  Store,  which  is  where  foreigners  can  buy  things. 

After  being  in  Peking  for  several  days,  we  visited  a  number  of 
hospitals  and  talked  with  the  staff  and  discussed  their  equipment  and 
what  they  were  doing.   They  were  all  terribly  friendly.   They  hang 
on  to  their  friendships.   I  keep  getting  letters  and  postcards  from 
them  even  now. 

Hughes:   Did  you  give  rounds? 

Gerbode:   Yes. 

Hughes:   So  the  purpose  really  was  to  get  information  from  you. 

Gerbode:   Yes,  but  also  to  exchange  ideas.   What  actually  happened  was  that 

Uncle  Sam  paid  for  our  transportation  to  China  and  the  Chinese  paid 
for  everything  else.  We  didn't  spend  any  money  at  all  except  if  we 
wanted  to  buy  something  in  the  Friendship  Store.  That  was  my  first 
trip. 

Then  a  year  and  a  half  went  by,  and  the  China  Scientific 
Cooperation  Committee — that  isn't  the  exact  title — was  developed  in 
Washington.   This  was  to  develop  mutual  understanding  between  the 
two  countries,  very  much  like  the  Russian  idea  was,  except  it 
seemed  to  me  it  was  built  on  individuals  rather  than  groups  of 
people  representing  specialties. 

So  they  asked  me  if  I  would  go  over  again,  and  I  said,  "Yes, 
under  what  circumstances?"  They  finally  told  me  they'd  like  to  have 
me  go  to  at  least  one  medical  school  and  give  some  lectures.   And 
would  I  go  to  Shanghai?   I  said  all  right. 


330 


Garbode:   So  I  went  over  as  an  individual,  gave  lectures  for  three  weeks  in 
a  medical  school  in  Shanghai,  had  rounds  with  their  patients, 
watched  them  operate,  and  discussed  their  operations. 

Hughes:   Was  this  on  contemporary  problems  in  heart  surgery? 

Gerbode:   It  was  all  heart  surgery.   They  documented  every  word  I  said,  and 

they  copied  all  my  lantern  slides.  They  worked  me  from  eight  o'clock 
in  the  morning  till  twelve  noon,  and  then  I  went  to  the  hotel  for 
lunch.   They  picked  me  up  at  one-thirty  again,  went  back  till  four. 

Hughes:   How  did  you  find  the  state  of  cardiovascular  surgery? 

Gerbode:  Well,  actually  I  could  see  that  technically  they  were  very  able. 

Their  machines  weren't  perfect.   They  made  them  themselves,  copying 
our  machines  of  maybe  ten  years  before.   The  way  they  handled  their 
blood  was  a  little  old  fashioned  and  probably  made  some  patients  sick. 
There's  no  plastic  industry  in  China,  so  they  again  used  rubber 
tubing,  which  they  washed  and  reused.   That  produces  a  lot  of  problems. 

Hughes:   Did  that  influence  the  length  of  operations  that  they'd  be  willing 
to  tackle? 

Gerbode:   It  made  people  sick;  that's  the  main  thing. 
Hughes:   But  they  had  to  do  it  anyway. 

Gerbode:  Yes.   This  main  hospital  was  really  something.   It  was  an  old 

building,  built  about  1850.   Cement  floors,  which  were  worn  down  from 
thousands  and  thousands  of  people  walking  over  them.   The  walls  had 
once  been  covered  with  some  kind  of  plastic  which  was  peeling  off. 
Everybody  in  the  whole  hospital,  including  staff,  were  fed  the  same 
meals.   The  patients  are  all  served  with  a  bowl  and  a  soup  plate.   It 
was  usually  rice  and  a  little  meat  broth  of  some  kind,  very  little 
vegetable  of  any  kind.   These  things  were  hauled  around  the  hospital 
on  great  carts,  getting  kind  of  cold  before  they  were  delivered. 
In  the  place  where  the  doctors  ate  it  seemed  to  me  the  meal  was 
almost  the  same. 

The  elevator  was  used  for  hauling  the  meals,  the  patients,  the 
staff,  and  everybody.   An  old  rickety  elevator  which  looked  as  though 
it  were  going  to  break  down  any  minute.  Not  very  big. 

Hughes:   Does  this  imply  that  there  isn't  money  in  China  for  medicine? 

Gerbode:  They  just  don't  have  enough  money  to  do  what  they  want  to  do  yet. 
They're  trying.  I  guess  what  they're  doing  mainly  now  is  putting 
their  money  into  industries  that  will  bring  them  some  currency,  like 


331 


Gerbode:   oil.   They're  developing  a  big  coal-mining  project,  which  the 

Bechtel  Corporation  is  helping  them  with,  of  taking  the  coal  out 
of  the  mines  and  putting  it  in  water  pipes.   They  pulverize  the 
coal,  put  it  in  a  suspension,  ship  it  somewhere  in  a  big  pipe  where 
it's  dried  out,  made  into  bricks,  and  sold  to  the  people.   That's 
a  cheaper  way  of  doing  it  than  putting  it  on  a  railroad  train. 

My  daughter  Maryanna  decided  she  wanted  to  come  over  and  join 
me,  so  she  got  a  visa  from  the  Chinese  consulate  for  herself  and  for 
her  daughter  Sarah  in  about  five  minutes,  and  all  of  a  sudden  they 
appeared. 

Hughes:    Unbeknownst  to  you. 

Gerbode:   I  had  a  suspicion  they  were  coming,  but  I  didn't  know  exactly  when. 
But  they  got  through  the  customs  by  themselves,  and  one  morning  they 
just  appeared  at  the  hotel.   Sarah  jogged  every  morning.   The  first 
morning  she  was  out  at  five-thirty,  and  she  came  back  at  seven.   We 
were  having  a  little  breakfast.  She  said,  "Papa,  there  are  people 
all  over  the  place  jogging  and  brushing  their  teeth  and  everything, 
old  people  and  everybody."   She  couldn't  understand  how  they  were 
all  out  there  early  in  the  morning  jogging  and  doing  all  these 
•things.   For  some  reason  the  Chinese  like  to  brush  their  teeth  out 
in  the  street  early  in  the  morning.   She  was  a  little  afraid  at 
first,  but  she  found  out  she  could  jog  among  them  and  get  back  to 
the  hotel. 

They  were  there  for  ten  days  and  had  a  grand  time,  and  was  I  glad 
to  see  them,  too!  You  know,  there  are  a  lot  of  little  things.   For 
example,  in  all  the  hotel  rooms  they  put  hot  water  for  tea  every 
morning  in  a  thermos  bottle.   These  thermoses  are  standard.   They 
must  make  millions  of  them  because  they're  all  the  same  all  over 
the  country.   So  you  can  either  have  tea,  or  coffee  if  you've  got 
the  coffee  to  make  it  out  of.   I  brought  some  instant  coffee  along 
with  me.   And  the  meals  are  about  the  same.   You  have  lots  of 
chicken  and  rice,  gravy,  and  once  in  a  while  some  beans  or  cucumbers. 
In  the  hotels  people  order  maybe  four  or  five  things,  and  there's 
all  this  tremendous  waste,  because  they  don't  eat  it  all.   I  don't 
know  what  happens  to  the  extra ,  but  I  suppose  a  lot  of  it ' s  thrown 
away.   And  the  inevitable  beer  at  any  meal;  you  can  get  all  the  beer 
you  want. 

ii 

Gerbode:   The  brandy  is  terribly  strong  and  not  very  palatable.   But  in  Peking, 
of  course,  there  are  many  things  to  see.   Outside  of  the  Great  Wall 
you  can  go  to  these  gorgeous  museums  and  all  these  [building]  which 


332 


Gerbode:  were  built  for  the  emperors  thousands  of  years  ago.  And  I  must 

say,  you  have  to  admire  the  craftsmanship.   It's  beautiful.   Their 
engravings  and  paintings  are  magnificent.   So  finally  that  was 
over  and  we  left  by  plane  for  Hong  Kong. 


Saudi  Arabia 


Hughes:   Would  you  like  to  tell  me  about  the  recent  spring  trip  to  Saudi 
Arabia? 

Gerbode:  Again,  you  don't  know  how  one's  name  gets  in  the  hat  in  any  of  these 
things.   But  anyway,  they  have  two  great  hospitals  in  Saudi  Arabia 
for  specialized  surgery.   One  is  in  Jedda,  which  is  on  the  coast, 
and  one  is  in  Riyadh,  which  is  about  five  hundred  miles  away,  to  the 
northeast.   Jedda  is  the  great  port  of  Saudi  Arabia.   Their  port 
facilities  are  great.   Riyadh  is  the  capital.   In  any  event,  I  was 
asked  aboug  six  months  ago  if  I'd  be  willing  to  go  to  an  inter 
national  symposium  there  to  be  put  on  by  a  group  of  men  chosen  from 
all  over  the  world,  one  or  two  from  each  country,  to  celebrate  the 
thousandth  open-heart  case  they'd  done  at  this  hospital  in  Jedda. 
They  have  beautiful  equipment  and  a  nice  modern  hospital. 

The  organizer  of  the  symposium  was  a  man  who ,  I  guess ,  had  some 
training  in  this  country.   He  spoke  perfect  English,  had  an  absolutely 
gorgeous  wife,  as  many  of  the  young  Arabian  and  Bedouin  women  are. 
When  they  get  to  be  about  thirty  years  old ,  they  begin  to  get  fat 
and  rounded.   But  when  they're  young,  they're  gorgeous. 

In  any  event,  the  meeting  was  held  in  a  big  central  auditorium, 
and  we  were  all  brought  over  with  all  expenses  paid.   First-class 
going  and  coming.   We  stayed  in  an  American-style  hotel,  a  Hyatt 
Regency,  if  you  can  believe  it.   There's  also  an  Intercontinental 
Hotel  there,  all  built  by  the  Saudis  with  the  participation  of 
various  countries,  principally  the  U.S.   The  country  is  dominated 
mainly  by  American  or  English  architects  and  builders.   However, 
there  are  other  countries  which  sometimes  contribute  some  architecture 
or  building  skills. 

In  any  event ,  there  were  about  ten  surgeons  in  our  group :   three 
from  this  country,  one  from  Taiwan,  one  from  China,  one  from 
Switzerland,  two  from  England,  one  from  Scandinavia  and  one  from 
Canada.   We  formed  a  kind  of  a  clinical  faculty,  and  they  had  already 
decided  what  we  were  to  talk  about,  having  been  warned  six  months 


333 


Gerbode:   before.   Actually,  what  they  had  selected  for  topics  was  really 
what  they  had  read  each  man  had  contributed  to  the  science  of 
cardiovascular  surgery. 

Hughes:   Whom  do  you  think  had  made  these  decisions? 

Gerbode:   The  surgical  director  of  the  hospital.   The  invitation  came  from  the 
minister  of  health.   I  mean,  that's  where  the  money  came  from.   I 
don't  know  how  much  the  minister  of  health  had  to  do  with  planning 
it,  but  he  was  there  every  day.   He's  a  rather  huge  man,  very  jocular. 

Hughes:   A  physician? 

Gerbode:   Yes,  I  think  he  was  a  physician.   Somewhere  he'd  picked  up  a  Ph.D., 
too.   His  last  name  was  something  like  Jaboom. 

The  wives  were  all  invited,  too,  and  expenses  paid  for  the  wives 
as  well.  All  first  class.   It  probably  cost  nine  thousand  dollars 
per  couple  to  bring  us  there.   Anyway,  we  were  met  at  the  airport. 
My  daughter  Maryanna  and  I  came  in  from  London.   Earlier  they  had 
some  question  about  whether  they  should  pay  for  Maryanna  since  she 
wasn't  a  wife.   But  I  simply  said,  "I'm  going  to  bring  her,  so  if 
you  don't  want  to  pay  for  her,  then  .that's  your  problem."  But  they 
paid  for  her.   Very  few  women  go  out  in  the  daytime.   But  they  do  go 
out  at  night,  usually  in  couples.   Maryanna  went  around  almost 
everywhere,  except  in  sacred  places,  with  two  other  ladies  who  were 
part  of  the  delegation. 

Hughes:   What  sort  of  feeling  did  you  get  about  Arabian  medicine? 

Gerbode:   Pretty  hard  to  tell,  although  their  figures  are  quite  good.   The 
mortality  rates  that  they  discussed  were  very  acceptable. 

Hughes:  What  about  their  equipment? 

Gerbode:  Equipment  is  first  class. 

Hughes:  Because  they  have  the  money. 

Gerbode:  They  have  the  money  and  they  can  buy  anything  they  want. 

Hughes:  Probably  very  little  of  it  is  indigenous. 

Gerbode:  Practically  nothing  is  indigenous  except  manpower. 

Hughes:   And  yet  the  people  at  the  head  in  the  past  have  all  been  foreigners, 
British  or  American.   Is  that  still  true? 


334 


Gerbode:   Yes.   For  example,  in  Riyadh  their  most  famous  hospital  is  a 

specialized  hospital  for  special  services,  which  means  brain  surgery, 
chest  surgery,  malignancy,  heart  surgery,  kidney  transplants.  Any 
thing  like  that  goes  to  this  hospital  if  they  can  get  in.   It's 
only  two  hundred  and  fifty  beds.   The  hospital  was  designed  by  an 
English  architect.   He  didn't  pay  his  subcontractors,  went  back  to 
England,  was  arrested,  and  presently,  I  think,  is  in  jail.   He 
designed  a  hospital  with  virtually  one  long  corridor,  about  a 
quarter  of  a  mile  long,  with  rooms  on  each  side. 

Hughes:   What  was  the  concept  there? 

Gerbode:  You'd  have  to  ask  him;  I  don't  know  why.   It'd  take  about  half  an 

hour  to  walk  from  one  end  to  the  other.   But  the  rooms  are  fantastic. 
The  operating  rooms  are  the  best  you  can  imagine.   Their  xray 
department,  instead  of  having  one  body  scanner,  they  have  two;  and 
the  lab  where  they  do  all  the  lab  tests ,  instead  of  being  designed 
for  two  hundred  and  fifty  beds,  it's  designed  for  a  thousand  beds. 
Any  kind  of  test  you  want  on  blood  or  urine  can  be  done  there ,  and 
they  have  all  these  automatic  instruments  for  testing  blood. 

Hughes:   Are  they  training  their  own  people? 

Gerbode:  Yes,  they're  trying  to  train  the  Saudis,  but  they  don't  seem  to  be 
learning  very  fast. 

Hughes:   Why  is  that? 
Gerbode:   I  don't  know  why. 

The  king,  of  course,  determines  everything  in  the  end.   There 
are  little  stores  all  over  the  downtown.   He'll  give  the  fellow 
an  interest-free  loan  to  set  up  a  little  store.   Then  the  fellow 
gets  people  to  run  the  business,  usually  a  Lebanese.   Then  when  it 
gets  going,  he  kind  of  retires  from  the  scene.   He  just  comes  in  and 
checks  on  it  once  in  a  while.   It's  kind  of  demeaning  for  him  to 
stand  there  all  day  long  and  run  the  business.   So  as  a  consequence, 
they're  not  really  learning. 

Hughes:   The  same  is  true  in  medicine? 

Gerbode:   1  think  it  is.   One  of  the  English  doctors  in  the  hospital  in  Riyadh 
said,  "Well,  we  make  rounds  at  seven  o'clock  and  make  all  the 
decisions;  at  eight  o'clock  the  Saudis  arrive,  and  the  decisions  are 
already  made." 


335 


Gerbode:   In  the  heart  program,  they  have  two  teams.   They  have  American 

teams  from  Houston,  which  go  there  in  groups  of  three  or  four  and 
stay  about  three  months  each  time.   They're  paid  very  well  by  the 
Saudis.   Then  the  same  day  at  the  same  time  they  have  a  Saudi 
team  doing  heart  cases,  maybe  with  an  American  or  an  English 
surgeon  helping. 

Hughes:  Is  there  any  difference  in  the  cases? 

Gerbode:  I  think  they  try  to  give  the  foreign  team  the  hardest  cases. 

Hughes:  Surely  there  must  be  some  system  of  training? 

Gerbode:  Not  all,  but  most,  of  the  residents  are  Saudis. 

Hughes:  So  they  would  be  assisting  the  American  team  from  Houston? 

Gerbode:  Yes.   Opportunities  for  learning  are  there,  all  right. 

Hughes:    Is  the  main  reason  for  the  Houston  team  being  there  to  do  the  cases, 
or  is  it  to  pass  on  its  knowledge? 

Gerbode:   It's  supposed  to  be  demonstrating  and  training. 
Hughes:   Then  why  keep  the  teams  so  separate? 

Gerbode:  Well,  I  guess  they  feel  they  can  train  the  residents  better  by 
showing  what  an  American  team  does. 

Hughes:   Do  you  think  the  Arab  team  had  received  training  in  the  United 
States? 

Gerbode:   Some  members  have  been  here.   But  now  it's  hard  for  them  to  get  real 
training  because  of  this  law  that's  been  passed  forbidding  foreign 
M.D.s  to  participate  in  clinical  training. 


Australia 


Hughes:    Shall  we  go  on  to  Australia? 

Gerbode:   The  Aurtralian  trip  was  a  meeting  of  the  Pan-Pacific  Surgical 

Society,  which  was  started  in  Honolulu  in  the  early  1920s.   It  has 
a  meeting  every  other  year,  and  all  the  meetings  until  this  one  have 
been  in  Honolulu.   They've  brought  people  from  all  over  the  Pacific 


336 


Gerbode: 


Hughes : 
Gerbode; 

Hughes: 
Gerbode: 


Hughes: 

Gerbode: 

Hughes: 

Gerbode: 

Hughes: 
Gerbode: 


basin  as  members  and  attendants  at  the  meetings,  and  they  also 
encourage  people  from  the  mainland  United  States  and  even  from 
Europe  to  come.   Hawaii  is  such  a  nice  place  to  go,  particularly 
in  the  winter.   So  the  attendance  has  always  been  very  good,  and 
the  meetings  have  always  been  very  successful. 

This  time  the  Australians  and  New  Zealanders,  who  have  quite 
a  large  membership  in  the  society,  persuaded  them  to  have  the 
meeting  in  Sydney.   It  was  quite  a  successful  meeting.   They  had  a 
little  over  a  thousand  people  signed  up  for  it. 


Even  though  people  are  escaping 
medical  or  surgical  meeting? 


local  winters,  it  is  a  serious 


Oh  yes.  The  subject  matter  is  always  really  quite  good.  It  may 
not  be  brand  new  on  the  scene,  [but]  it's  contemporary  and  first 
class. 

Do  they  tend  to  be  leading  figures  in  that  particular  field? 

Yes,  they're  usually  first-class  people.   The  other  thing  they  have 
which  is  quite  good,  is  very  open  discussions.   If  you  get  a  lot  of 
big  leaguers  there  who  are  discussing  a  given  subject  in  which  they 
are  knowledgeable,  it's  very  interesting.   They'll  really  talk 
straight  about  it. 

One  thing  they  didn't  do  this  time,  which  they  do  in  Honolulu, 
is  have  breakfast  meetings  at  seven  o'clock  in  the  morning  where 
they  have  very  frank  discussions  of  the  subject  matter. 

So  there's  an  assigned  topic  for  the  breakfast. 
Yes. 

I  know  you  gave  the  introductory  talk,  "Turning  Points  in  Cardio 
vascular  Surgery,"  that  opened  the  meeting.  Do  you  know  how  that 
came  about? 

It  came  about  because  one  of  my  trainees  was  in  charge  of  the 
planning  committee ,  and  I  guess  he  wanted  to  do  something  nice  for 
the  old  man. 

[laughs]   That  was  all  there  was  to  it? 

I  had  enough  friends  around,  I  guess,  so  they  accepted  the  idea. 
John  Wright  is  the  man  who  did  this.   He's  one  of  the  most  successful 
cardiac  surgeons  in  Australia.   A  very,  very  nice  guy.  While  I  was 
there  I  saw  five  men  who'd  trained  in  my  department. 


337 


Hughes:   All  doing  well? 

Gerbode:   All  doing  very  well. 

Hughes:   Anything  more  that  you  can  think  of  on  the  subject  of  trips? 

Gerbode:   I  could  say  something  about  Australian  medicine  in  general.   They're 
going  through  a  terrible  upheaval  because  the  ministry  of  health 
and  the  politics  of  the  country  is  so  radical,  so  socialized,  that 
they  are  really  trying  to  squeeze  into  the  English  type  of  national 
health  insurance,  doing  it  in  various  slithery  ways  which  are  too 
apparent  to  the  doctors ,  and  the  doctors  are  rising  up  and 
complaining  at  every  turn  of  the  road.   In  fact,  in  one  or  two 
towns  they've  actually  had  a  strike  rather  than  adopt  the  measures 
proposed  by  the  minister  of  health.   The  minister  of  health  came 
and  talked  to  the  group.   He  sounded  either  like  an  out-and-out 
Communist  or  a  dictator. 

Hughes:    Is  it  very  much  along  the  lines  of  the  National  Health  Service  in 
Britain? 

Gerbode:   Yes,  it  is.   But  the  Australian  doctors  don't  want  it,  and  they're 
fighting  it.   The  same  thing  is  happening,  actually,  in  Canada. 

Hughes:   Will  it  come  to  be,  do  you  think,  in  both  places? 

Gerbode:   Well,  it's  coming  to  be — it's  a  matter  of  degree,  I  guess,  how  much 
they  can  shove  down  the  doctors'  throats.   I  may  sound  like  too 
much  of  a  rightist  on  this  subject  to  you,  but  actually  the  things 
they  say  about  the  medical  profession,  bad  as  it  may  be  in  spots, 
are  really  quite  awful . 

Hughes:    Such  as  what? 

Gerbode:   Well,  they  try  to  point  doctors  out  as  only  being  interested  in 
making  money  and  not  caring  about  the  patients,  fees  being  too 
high,  and  all  that.   I  think  they  are  too  high  in  some  respects,  but 
you  don't  have  to  change  the  whole  system  because  some  people  are 
not  being  nice.   They're  really  having  some  battles  down  there. 


338 


X  FURTHER  COMMENTS  ON  MEDICAL /SURGICAL  TOPICS 
[Interview  14:  April  23,  1984] If 

NIH  Support  of  the  Multidisciplinary  Team  in  Cardiovascular  Surgery 

Hughes:   The  National  Heart  Institute  awarded  its  first  grants  in  1949.   In 
1959  when  Stanford  pulled  out  and  Presbyterian  Hospital  and  the 
Institutes  of  Medical  Sciences  came  into  being,  NIH  granted  your 
heart  institute  $400,000  a  year  for  about  ten  years.   Had  you 
received  NIH  money  before  that? 

Gerbode:   I  think  we  had  soiae  before  1959,  but  we  didn't  get  a  big  grant  until 
they  decided  to  move  the  medical  school  to  Palo  Alto.   I  believe  part 
of  NIH's  feeling  in  the  background  was  that  they  wanted  to  retain 
some  sort  of  an  educational  research  facility  on  the  campus  of  the 
old  medical  school,  because  after  all,  historically  it  was  the 
first  medical  school  in  the  West  and  had  trained  many  physicians  and 
made  many  contributions  in  research.   Since  many  of  the  faculty 
decided  not  to  move  to  Palo  Alto,  I  think  NIH  basically  was  rather 
anxious  to  keep  it  going. 

Furthermore,  we  had  a  very  vigorous  research  and  development 
program  in  cardiovascular  surgery.   They  recognized  this  and  were 
happy,  I  guess,  to  fund  it.   In  any  event,  when  I  prepared  the  first 
application,  the  committee  came  out  and  surveyed  me  about  it  and 
said,  "You  should  apply  for  everything  you  will  require."  I  put  in 
an  application  for  over  a  million  dollars  a  year!   In  the  end  they 
gave  us  a  little  over  $400,000  a  year,  which  really  vas  the  basic 
reason  we  were  able  to  put  together  a  first-rate  cardiovascular  group 
and  institute  on  the  old  medical  school's  cafnpus.   This  went  on 
every  year.   We  had,  of  course,  to  tell  what  we  were  doing,  and  NIH 
had  to  [base  the  new  grant]  on  what  our  progress  reports  amounted  to. 
It  wasn't  just  a  handout.  We  had  to  prove  ourselves  every  year, 
which  I  think  we  did  quite  well. 


339 


Hughes:   What  sort  of  things  were  they  looking  at? 

Gerbode:   Publications,  improvements,  development,  contributions  to  the  field, 
training. 

Hughes:   Do  you  think  the  fellows  program  had  a  large  impact? 

Gerbode:   The  fellows  program  made  a  difference,  because  they  obviously  felt 
that  I  could  train  people,  and  so  they  gave  me  a  training  program. 
They  gave  me  a  very  small  amount,  about  $5,000  per  year  per  trainee, 
which  was  enough  money  in  those  days.   I  had  a  fellow  paid  for  by 
NIH  for  at  least  five  years,  and  I  had  many  other  fellows  during 
that  same  time.   I  raised  money  privately  to  support  them.   These 
fellows  are  now  scattered  all  over  the  world  and  very  happy 
apparently  to  have  been  here. 

Hughes:   Was  over  $400,000  an  unusually  large  grant  at  that  time? 

Gerbode:   It  probably  was  in  the  upper  10  percent  of  the  big  grants  in  the 

country,  but  people  like  Mike  DeBakey  were  getting  equal  amounts  of 
money,  and  I  guess  there  were  other  centers  in  the  country  that  NIH 
felt  had  the  possibility  of  developing  something  unusual.   I  imagine 
that  the  University  of  Minnesota  would  always  emerge  as  being  one  of 
the  early  groups  to  get  large  grant  money,  because  it  was  doing  such 
a  good  job  and  had  been  doing  it  for  quite  a  while. 

Hughes:    Government  intervention  in  medicine  and  the  sciences  is  largely  a 
postwar  phenomenon.   Do  you  think  that  NIH  can  be  credited  to  a 
certain  extent  with  the  fact  that  cardiovascular  surgery  when  it 
began  to  take  off  was  largely  an  American  phenomenon? 

Gerbode:   Well,  it's  certainly  true  that  without  NIH  help,  we  wouldn't  have 
gone  nearly  as  far  as  we  did  in  the  beginning,  or  since  then.   The 
American  Heart  Association  helped  a  good  deal,  but  it  doesn't  have 
the  amount  of  money  NIH  has. 

For  example,  I  got  Mr.  Bramson,  who  was  our  engineer  for  many 
years,  to  come  to  our  group  in  the  early  '50s.   He  didn't  know 
anything  at  all  about  blood  or  the  physiology  of  the  circulation, 
but  he  was  a  fantastically  intelligent  man  and  a  very  fine  engineer. 
So  we  put  in  an  application  to  the  American  Heart  Association  to 
have  him  appointed  as  an  established  investigator,  and  for  some 
reason  they  made  him  the  first  engineer  in  this  category  in  the 
country.   No  one  before  had  ever  gotten  one  of  these  grants  from 
the  American  Heart  Association  without  being  an  M.D.   I  can  assure 
you  that  their  money  was  extremely  well  invested,  because  throughout 
the  years  Bram  made  a  lot  of  very  good  contributions  in  the  field  of 
cardiovascular  surgery. 


340 


Hughes:   Was  that  the  beginning  of  the  teamwork  concept  in  cardiovascular 
surgery? 

Gerbode:  Yes,  that  was  the  first  time,  really,  that  people  realized  that  to 
push  this  field  forward,  you  couldn't  depend  entirely  on  M.D.s;  you 
had  to  have  Ph.D.s  and  others  who  could  back  up  the  whole  program. 
So  we  brought  Ph.D.s  to  the  bedside,  so  to  speak,  and  said,  "Here's 
the  problem  with  measuring  this  or  that,  and  how  would  you  solve  it?" 
We  had  a  number  of  people  like  Bram  who  worked  with  us  at  the 
bedside  on  clinical  problems ,  and  they  helped  us  a  great  deal  to 
solve  them,  and  established  the  principle  of  a  team  working  on  the 
clinical  problems  of  sick  people.   It's  amazing  how  quickly  they 
could  understand  the  physiology  of  a  clinical  problem  and  offer 
suggestions. 

This  is  particularly  true  later  on  when  we  got  the  monitoring 
people  in  to  work  with  us.   They  were  all  Ph.D.s  and  not  very 
knowledgeable  about  the  physiology  of  sickness,  but  they  could  see 
what  we  wanted  to  find  out,  and  they  applied  their  methods  to 
solving  the  problems,  and  were  fantastic  in  how  quickly  they  under 
stood  and  came  forward  with  suggestions  and  solutions. 

Hughes:   IBM  was  the  corporation  that  was  first  involved  with  computerized 
monitoring  [at  Presbyterian] .   Was  that  the  first  time  they  had 
collaborated  with  medical  people? 

Gerbode:  No.   They  had  worked  with  the  Mayo  Clinic  before  that,  but  they 
wanted  to  go  into  a  more  serious  large-scale  program,  and  they 
looked  over  the  country  to  decide  where  they'd  put  their  money.  And 
for  some  reason  they  came  to  us.   I  think  one  of  the  reasons  was 
that  we  were  small  and  had  a  small  group  who  could  work  well.  We 
had  many  patients,  and  there  weren't  any  other  things  that  would 
interfere  with  the  research  program.  We  could  do  it  pretty  much  on 
our  own,  and  they  liked  that.   They  had  looked  at  Texas  and  various 
other  places  before  they  came  to  us. 

Hughes:  This  was  early  "60s? 

Gerbode:  Yes. 

Hughes:  Did  other  centers  have  people  like  Bram? 

Gerbode:  The  other  centers  began  to  have  people  like  Bram. 

Hughes:  So  it  wasn't  by  then  unusual  to  have  a  bioengineer  on  the  team. 


341 


Gerbode:   Oh  no.   By  that  time  whole  schools  of  biomedical  engineering  were 
developing,  and  one  of  the  biggest  ones  was  in  Chicago.   They  were 
turning  out  biomedical  engineers  who  were  Ph.D.s  really  faster,  I 
think,  than  they  could  be  absorbed. 

Hughes:   Do  you  think  the  heart-lung  machine  was  the  original  impetus? 

Gerbode:   Part  of  that  was  the  development  of  the  heart-lung  machine;  there's 
no  question  about  that. 


The  Artificial  Heart  Program 


Hughes:    In  1964  the  National  Heart  Institute  drew  up  a  crash  program  for  the 
construction  of  an  artificial  heart  with  an  energy  source  to  be 
completely  implanted  within  the  patient's  chest.   The  first  artificial 
heart  was  to  be  implanted  on  Valentine's  Day,  1970,  and  as  we  know, 
this  goal  was  not  reached.   Do  you  know  anything  about  this  program? 

Gerbode:   I  think  the  artificial  heart  program  really  was  pushed  forward 

faster  than  anything  else  by  the  fact  that -Christiaan  Barnard  put 
in  a  heart  in  Cape  Town,  South  Africa.   This  was  kind  of  embarrassing 
for  this  country  to  have  a  South  African  do  this  when  we  had  spent 
so  much  money  on  this  sort  of  thing.   So  they  quickly  looked  over  the 
whole  field  and  decided  they'd  better  get  an  artificial  heart  program 
going,  too. 

Hughes:   Now  who  is  they? 

Gerbode:   I  guess  the  advisors  of  NIH.   Then  there  was  a  group  under  Kolff  in 
Salt  Lake  who  had  already  developed  the  artificial  kidney,  and  they 
were  a  very  busy,  active  research  group  and  were  doing  excellent 
work.   It  was  natural  for  them  to  take  on  an  artificial  heart 
program,  since  they  had  developed  an  artificial  kidney.  So  they  got 
some  of  the  first  grants,  but  there  were  other  grants  given  to 
various  centers  in  the  country,  including  our  center  under  Dr.  Hill. 

I  remember  being  on  an  artificial  heart  program  committee  at 
NIH.   We  made  certain  recommendations  to  NIH  about  the  development 
of  an  artificial  heart  program.   As  far  as  I  can  remember,  NIH  didn't 
follow  any  of  our  recommendations,  but  they  developed  an  artificial 
heart  program  anyway.   They  just  didn't  do  it  the  way  we  suggested 
doing  it.   But  they  did  a  good  job. 

Hughes:    I  gather  that  you  thought  that  such  a  program  was  feasible? 


342 


Gerbode:  We  suggested  it  was  feasible,  and  we  suggested  more  or  less  how  to 
do  it.   One  of  the  things  we  suggested  was  that  business  should 
collaborate  with  universities  or  laboratories  in  developing  an 
artificial  heart.   We  in  fact  suggested  certain  business  firms  to 
work  on  this,  because  it's  a  big  engineering  problem. 

Hughes:  And  did  NIH  take  up  that  aspect? 

Gerbode:  Yes. 

Hughes:  Do  you  remember  where  they  did  things  differently? 

Gerbode:  No,  I  can't  remember  where  they  put  their  emphasis. 

Hughes:  The  Houston  group  received  most  of  money? 

Gerbode:   The  Houston  group  got  some  of  the  money  but  not  any  more  than  anybody 
else.   I  think  probably  more  money  went  into  Salt  Lake,  the 
University  of  Utah,  than  almost  any  other  place. 

Hughes:   And  did  that  boil  down  to  track  record? 

Gerbode:  Well,  they  funded  them  because  they  had  a  -laboratory  going  employing 
techniques  and  research  people  on  this  other  problem  [the  artificial 
kidney]. 


Targeted  Medical  Research 


Hughes:   What  do  you  think  about  very  specifically  targeted  research  such  as 
this? 

Gerbode:  Well,  another  big  question  that  came  up  at  the  same  time  as  the 

artificial  heart  program  [was]  whether  or  not  NIH  should  put  their 
money  into  targeted  research.   It's  interesting  that  you  should 
ask  the  question,  because  before  that  decision  was  made,  people 
would  consider  research  something  that  would  just  come  along  out 
of  the  minds  of  research  people.   But  then  when  you  look  at  various 
problems  in  research,  or  in  medicine,  it's  very  easy  to  think  of 
applying  targeted  research  to  certain  basic  problems.  Well,  for 
one  thing  they  decided  arteriosclerosis  was  very  important  and  they 
shoi-ld  have  targeted  research  that  would  develop  methods  of  under 
standing  and  preventing  arteriosclerosis.  That's  targeted  research; 
they  put  a  lot  of  money  into  arteriosclerosis  research. 


343 


Gerbode:   Another  way  of  getting  targeted  research  is  to  have  a  prominent 

senator  or  president  or  vice-president  get  a  disease,  and  all  of  a 
sudden  there's  targeted  research  developed  around  that  particular 
disease. 

Hughes:   Do  you  have  any  idea  whether  in  the  long  run  this  is  a  profitable 
way  of  spending  money? 

Gerbode:   I  guess  the  term  "profitable"  means  whether  in  terms  of  spending  money 
there's  a  bigger  yield  for  the  money  spent  in  doing  it  that  way. 
I  can't  answer  that  question.   Right  now,  for  example,  there's  a 
great  deal  of  thought  about  work  in  immunology,  and  things  like 
interferon  and  other  methods  of  controlling  the  rejection  phenomenon 
are  very  important.   Whether  they  want  to  call  it  targeted  research 
or  not,  they're  putting  an  awful  lot  of  money  into  it  because  it's 
terribly  important.   Scientists  as  a  whole  realize  it  is  important, 
so  they're  spending  a  lot  of  time  on  it. 

Hughes:   It  seems  to  me  that  the  fact  that  government  in  most  countries  now 

(at  least  most  governments  in  the  Western  world)  plays  a  larger  role 
in  research  than  it  ever  has  done  in  the  past  changes  the  whole  tune 
of  things,  because  you  now  get  people  making  decisions  about  what  a 
scientific  effort  should  be,  when  in  the  past  that  has  been  largely 
left  up  to  the  individual.   Basic  research  led  to  applications  which 
the  individual  himself  may  never  have  foreseen. 

Gerbode:   It's  a  very  complicated  process,  because  each  individual's  application 
for  money  goes  through  a  peer  group  that  analyzes  his  proposal  and 
what  he  wants  to  do.   That  peer  group  has  a  tremendous  amount  of 
influence  over  whether  or  not  it  gets  funded.   I  would  say  on  the 
whole  the  peer  group  approval  of  an  individual  research  worker's 
proposal  is  a  very  good  way  to  do  it.   On  the  other  hand,  it  does 
subject  his  ideas  to  a  committee  for  committee  approval,  which 
sometimes  is  not  very  good.   However,  there's  no  question  that  in 
this  country  we've  made  many  more  contributions  with  our  particular 
system  of  giving  money  for  research  than  any  other  country.   But  I 
must  say  that  there  is  excellent  research  product  in  other  countries 
with  a  completely  different  system,  mainly  due  to  the  fact  that 
individuals  by  their  ability  can  produce  things  which  sometimes  are 
better  than  the  committee  activity. 

Hughes:   On  the  other  hand,  research  has  gotten  to  be  such  an  expensive 
proposition,  particularly  in  the  medical  sciences,  that  it's  no 
longer  the  individual  scientist  working  alone  in  his  .lab  that  really 
can  hope  to  make  many  contributions,  so  the  individual  is  almost 
forced  to  become  a  part  of  the  group  in  order  to  produce. 


344 


Gerbode:  Yes,  and  this  influences  the  peer  group  evaluation  of  a  proposal. 

One  of  the  first  things  they  look  at  is  whether  or  not  the  laboratory 
is  adequate  to  do  what  the  man  wants  to  do  and  whether  he  has  enough 
help  to  do  it. 


The  Transventricular  Mitral  Valve  Dilator 


Hughes:   We  talked  a  little  bit  about  the  transventricular  mitral  valve 

dilator,  although  I  don't  think  we  called  it  that,  and  I  was  wondering 
if  you'd  tell  me  a  little  bit  more  about  how  you  came  to  devise  it. 

Gerbode:  We  were  using  finger  fracture  methods  of  fracturing  the  mitral  valve, 
and  occasionally  using  an  instrument  to  cut  the  valve.  We  very 
quickly  found  that  cutting  the  valve  was  not  very  satisfactory 
because  you  couldn't  cut  it  blindly  through  the  atrium  or  through 
the  ventricle  with  an  instrument  without  sometimes  cutting  the  wrong 
place,  and  therefore  making  a  tight  valve  an  incompetent  valve. 
This  was  found  out  early  on  by  Cutler  and  Beck  when  mitral  valve 
surgery  started  becoming  a  reality. 

Once  you  felt  these  valves  and  fractured  them  with  your  finger, 
you  realized  that  the  commissures  were  giving  away  and  opening  up 
rather  than  some  other  place  on  the  valve.   Both  commissures  would 
usually  open  because  they  were  stuck  together  less  securely  than 
the  rest  of  the  valve.   So  various  people  devised  these  valvotomies. 
One  very  good  one  was  under  Andrew  Logan  in  Edinburgh,  who  developed 
one  which  was  used  a  lot  in  Europe,  mainly  in  the  United  Kingdom. 

My  concept  was  a  little  different  in  that  I  controlled  the 
amount  of  fracture  of  the  valve  gradually  with  a  special  little 
screw  attachment  which  would  let  you  open  it  slowly.   You  could  feel 
the  valve  at  the  same  time,  so  that  you  wouldn't  tear  the  tissues 
apart  too  quickly.   This  became  quite  an  acceptable  valvotomy 
instrument  in  this  country. 

Hughes:   But  not  abroad? 

Gerbode:  Yes,  it  was  used  abroad,  too.  Finally  the  Pilling  Company  had  the 
instrument  made  in  Germany.  They  felt  that  the  Germans  could  make 
it  more  cheaply  and  better  than  they  could  in  this  country. 


345 


The  First  Open  Heart  Surgery  Team  on  the  West  Coa st 


Hughes:    I  thought  you  should  say  a  little  more  about  the  fact  that  your 
team  was  the  first  open  heart  surgical  team  on  the  West  Coast. 

Gerbode:   I  guess  this  came  about  because  we  were  so  busy  trying  to  put 

together  a  heart-lung  machine,  and  we  really  had  quite  a  few  patients 
around  the  place,  mainly  because  of  our  very  fine  pediatric 
cardiology  outpatient  clinic.   This  was  under  the  direction  of  Dr. 
Ann  Purdy,  who  was  Dr.  Holman's  wife.   She  had  a  lot  of  patients 
with  congenital  heart  disease.   Then  we  knew  that  there  were  plenty 
of  patients  that  needed  care. 

So  we  devised  a  number  of  heart-lung  machines,  with  Dr.  Osborn 
being  in  charge  of  the  early  ones.   Later  on  Mr.  Bramson  came  into 
the  picture  and  designed  several.  We  had  various  emissaries  from 
the  University  of  California  who  were  in  charge  of  thoracic  and 
cardiovascular  surgery  there  come  over  and  take  a  look  at  what  we 
were  doing,  and  were  a  little  dubious  that  we  could  do  it,  I  think. 
However,  in  time  they  realized  we  could  do  it. 

Some  of  our  early  efforts  in  repairing  congenital  defects  of 
the  heart  were  not  successful,  mainly  because  the  machines  we  were 
using  weren't  entirely  good.   They  were  the  best  we  could  design 
at  the  time.   However,  teamwork  is  very  important,  and  we  very  soon 
realized  that  if  we  made  a  mistake  or  didn't  work  out  something  the 
way  it  should  be  worked  out,  that  we  should  make  the  improvement 
right  away  before  the  next  case.   And  this  is  what  we  did.   So 
eventually  it  became  rather  successful.   This  was  the  first  open 
heart  surgical  team,  I  guess,  on  the  West  Coast.   Actually  it  was  a 
little  bit  ahead  of  the  Houston  group,  who  came  along  six  months  or 
a  year  later. 

Hughes:   Would  you  like  to  say  something  about  the  membership  of  that  team? 

Gerbode:   The  membership  was  really  based  on  Mr.  Bramson,  Jack  Osborn,  and 
my  fellows,  who  were  all  very  anxious  to  get  things  going.   They 
realized  that  this  was  something  that  had  a  big  future,  so  they 
worked  very  hard  in  the  laboratory  and  also  clinically  to  push  the 
field  forward. 

Hughes:    How  much  of  the  operating  were  the  fellows  doing? 

Gerbode:   They  always  assisted  me,  and  I  would  let  them  do  the  parts  of  the 

operations  that  I  felt  that  they  could  do  safely.   Some  of  them  were 
better  than  others.   Some  of  them  were  so  good  they  could  do  the 
whole  thing.   Others  would  do  parts  of  the  operation.   Eventually, 
when  they  went  back  home,  they  did  everything,  and  very  well. 


346 


Hughes:   What  were  the  main  types  of  operations  that  you  were  doing  in  those 
early  days? 

Gerbode:   Pulmonary  valvotomy  was  one  of  the  early  cases,  because  that  was 
something  you'd  get  in  and  out  in  a  hurry. 

Hughes:   Now  this  was  with  the  heart-lung  machine? 

Gerbode:  Yes.   We  did  some  pulmonary  valvotomies  without  the  heart-lung 

machines,  blind  ones;  they  weren't  very  satisfactory.   In  fact,  we 
had  Mr.  Russell  Brock  come  over  from  London  as  a  guest  professor., 
and  he  did  a  number  of  blind  pulmonary  valvotomies  without  the 
heart-lung  machine,  but  we  in  the  end  had  to  do  them  over  again 
because  they  were  not  very  adequate.   They  were  adequate  for  a  time 
but  not  adequate  for  the  long  haul. 

Hughes:   Was  the  main  problem  not  being  able  to  see? 

Gerbode:  Yes,  and  not  having  time.   It  takes  time  to  do  these  things  right. 

So  then  we  went  from  pulmonary  valvotomies  to  atrial-septum  defects — 
that's  the  hole  on  the  right  side  of  the  heart.   They  were  easier  to 
do,  and  the  results  were  very  satisfactory.   So  we  did  a  group  of 
atrial-septal  defects. 

The  main  thing,  of  course,  in  those  days  was  to  do  operations 
which  would  give  the  pediatricians  and  the  cardiologists  confidence 
in  what  you  were  trying  to  do.   So  you  couldn't  have  very  many 
complications  and  fatalities;  otherwise  they'd  turn  off  the  spigot, 
entirely.   But  we  were  able  to  select  the  cases  that  in  the  early  days 
gave  us  good  results  with  very  low  mortality  and  morbidity  rates. 
Then  as  confidence  grew  among  the  referring  physicians,  we  took  on 
more  complicated  cases.  We  had  a  lot  of  tetralogies,  blue  babies, 
to  do  because  we  had  done  a  lot  of  Blalock  procedures  on  them  before — 
a  palliative  operation — so  they  were  more  or  less  our  patients  because 
we  had  operated  upon  them  before.   So  as  soon  as  the  machines  got 
good  enough,  we  began  to  operate  upon  tetralogy  patients  for 
complete  repair,  and  we  were  lucky  because  we  found  the  mortality 
rate  was  pretty  low  and  the  success  rate  was  really  quite  good. 

Hughes:   What  was  the  success  rate  mainly  due  to? 

Gerbode:   I  think  probably  just  the  fact  that  we  were  operating  everyday,  and 
everyday  we  learned  something  and  we  applied  what  we  learned. 

Hughes:   Do  you  think  you  were  putting  more  care  into  the  selection  of  patients 
than  other  teams? 


347 


Gerbode:   No,  we  were  just  ahead  of  them. 

## 

Gerbode:   Later  on  as  the  work  progressed,  we  found  that  there  were  a  lot 
of  surprises,  as  we  got  into  more  complicated  cases.  But  then  we 
had  more  time  so  that  we  could  sort  out  the  problems  and  end  up 
with  a  satisfactory  result. 

Hughes:    Time  because  the  heart-lung  machine  was  improved  by  then? 
Gerbode:   Yes.   The  heart-lung  machine  was  improving  all  the  time,  too. 

Hughes:   Was  there  much  change  in  the  diagnostic  procedures  within  that 
period  of  ten  years  or  so? 

Gerbode:   Yes,  cardiac  catheterization  and  angiocardiography  were  becoming  more 
accurate,  and  the  cardiologists  and  roentgenologists  were  much  more 
accurate  in  making  a  diagnosis,  which  was  important. 

Hughes:   Was  that  a  matter  more  of  people  than  the  instrumentation? 

Gerbode:   I  think  it  was  a  matter  of  experience.   We  had  a  very  fine  angio- 
cardiographic  machine,  one  of  the  first  on  the  West  Coast.   It  was 
great  for  about  three  years,  and  then  another  one  came  out  which 
was  much  better.   The  field  was  moving  ahead  so  rapidly  that  you 
had  to  expect  that  these  big  companies  coming  into  the  picture  would 
see  the  advantage  of  having  something  better,  and  they  were  working 
very  hard  all  the  time,  too,  to  improve  things. 

Hughes:   Were  these  techniques  now  accepted  parts  of  a  residency  program,  so 

that  a  resident  in  cardiology  would  automatically  learn  catheterization? 

Gerbode:   Yes,  residents  in  cardiology — they  were  fellows,  really — originally 
learned  how  to  do  cardiac  catheterization  under  guidance  from  the 
senior  people,  and  the  residents  in  roentgenography  would  learn  how 
to  interpret  the  angiocardiographic  procedures.   It's  very  easy  for 
a  roentgenologist  to  inject  the  dye,  but  the  hard  part  is  interpreting 
what  the  dye  shows  them  inside  the  heart.   So  this  was  all  part  of 
the  learning  process.   Every  patient  who  was  studied  this  way,  was 
studied  by  the  senior  people  as  well  as  the  junior  people.   And  the 
surgeon  would  always  look  over  all  the  studies,  too,  with  the  roentgen 
ologist.   Sometimes  they  wouldn't  agree,  but  most  often  they  all 
agreed  that  the  anatomy  was  such-and-such  and  proceeded  accordingly. 


348 


Endocardial  Cushion  Defects 


Hughes:   The  subject  of  endocardial  cushion  defects.  You're  known  for 
devising  surgical  procedures.   Can  you  explain — ? 

Gerbode:  As  we  were  doing  more  and  more  atrial  septum  defects,  we  began  to 
encounter  patients  who  had  not  only  an  atrial  septal  defect ,  but 
other  abnormalities  of  the  valves  on  that  side  of  the  heart.   So  as 
we  became  technically  more  able,  we  began  to  repair  some  of  the 
more  complicated  forms  of  atrial  septal  defect  with  the  valve 
abnormalities,  and  I  suppose  we  were  lucky  in  being  able  to  sort  out 
some  of  these  complex  anomalies  and  correct  them. 

Luckily,  we  also  had  a  fairly  generous  supply  of  these  patients, 
so  that  we  were  able  to  learn  rather  fast.   There's  nothing  more 
spectacular  than  to  correct  an  atrial  septal  defect  with  valve 
abnormalities  and  the  endocardial  cushion  defect.   The  result  is  so 
spectacular.  You  take  a  child  who  has  severe  heart  failure  and 
really  make  a  normal  child  out  of  him. 

Hughes:   Between  the  beginning  and  the  end  of  the  operation;  is  it  that 
clear? 

Gerbode:  Well,  from  the  beginning  of  the  operation  till  he  recovers  from  the 
operation.   One  spectacular,  case  was  a  young  woman  with  a  severe 
endocardial  cushion  defect  and  heart  failure.   I  was  able  to  sort 
this  out  and  correct  it.   She  had  two  valves  involved  and  two  holes 
in  her  heart,  one  in  the  ventricle  and  one  in  the  atrium.   Two 
valves  that  were  split.   Well,  I  was  able  to  patch  up  that  heart, 
and  she  walked  out  of  the  hospital  ten  days  later,  and  subsequently 
got  married  and  was  a  very  strong  housewife.   Then  she  got  pregnant; 
her  first-born  male  child  had  the  same  defect  that  she  had.   She 
was  an  awfully  good  mother.   This  child  was  in  heart  failure  almost 
from  the  very  beginning.   I  did  a  palliative  operation  to  cut  down 
on  the  flow  of  blood  to  the  child's  lungs  to  hold  him  for  a  while, 
because  I  didn't  think  I  should  operate  for  complete  repair  when  he 
was  so  young.   These  days  they're  doing  these  operations  in  a  younger 
age  group.   However,  the  palliative  operation  held  him  for  about 
three  or  four  years,  and  then  he  began  to  not  do  very  well  even 
with  the  palliative  operation.   So  I  did  a  complete  repair,  and  he 
had  exactly  the  same  combination  of  defects  that  the  mother  had.   I 
was  able  to  correct  them  the  same  way  as  I  had  done  in  the  mother. 
Every  Christmastime  I  get  a  picture  of  this  boy  and  a  little  note  from 
the  mother  telling  me  how  well  he's  doing. 


349 


The  Membrane  Oxygenator 


Hughes:   We  talked  about  the  membrane  oxygenator,  but  you  didn't  bring  it 
up  to  the  final  stages  with  the  Harvey  Company. 

Gerbode:   I  first  met  Mr.  Bramson  at  a  cocktail  party  in  Paris  being  given 

by  some  local  friends  who  happened  to  be  there,  and  they  invited  Bram 
to  come  along  because  he  was  an  engineer  with  them.   They  were 
just  about  terminating  his  work  with  them,  which  had  to  do, 
curiously,  with  the  left-over  wood  from  the  lumber  industry. 

[phone  interruption] 

Gerbode:   Bram  said  he  was  not  going  to  be  busy  with  Mr.  Heller  after  a  certain 
time,  and  I  said,  "Well,  would  you  like  to  work  on  a  membrane 
oxygenator?"  "Well,"  he  said,  "I  don't  know  what  it's  all  about, 
but  I'll  be  happy  to  work  on  something  like  that  with  your  group  if 
you  think  it's  very  important."  I  said,  "It's  going  to  be  very 
important . " 

So  Bram  came  on  as  a  consultant.   We  got  him  approved  by  the 
American  Heart  Association,  as  I  mentioned  previously,  and  he 
started  working  on  a  membrane  oxygenator  in  our  research  group , 
without  having  done  anything  before  with  blood  or  biology  in  his 
whole  life. 

Hughes:   How  far  along  were  you  with  the  oxyg;enator  when  Bram  came  in? 

Gerbode:   We  weren't  anywhere  at  all  with  the  membrane  oxygenator  when  I  got 
him.   We  had  some  other  prototype  oxygenators. 

So  Bram  came  aboard  in  our  little  research  group ,  and  we  very 
quickly  realized  that  developing  a  membrane  oxygenator  that  would 
be  clinically  useful  was  going  to  take  a  lot  more  than  just  a  few 
weeks  or  months.   So  Bram  then  devised  another  type  of  disk 
oxygenator  which  was  useful  to  keep  things  going.   It  was  a  disk 
type  of  oxygenator,  which  I  used  in  about  three  hundred  cases,  I 
guess,  while  we  were  trying  to  develop  a  membrane  oxygenator. 
Meanwhile,  he  was  doing  work  with  Mr.  William  Tyson,  another 
engineer,  and  Cutter  Laboratories  in  Berkeley,  developing  a  prototype 
membrane  oxygenator  while  we  were  using  his  disk  type  of  oxygenator. 
Finally,  after  a  couple  of  years,  we  developed  a  prototype  membrane 
oxygenator,  which  was  clinically  very  good.   The  only  problem  with 
it  was  that  it  had  to  be  put  together  by  hand  every  time. 

Hughes:   When  was  this? 


350 


Gerbode: 


Hughes: 
Gerbode: 


Hughes : 
Gerbode: 


Hughes: 
Gerbode: 


Hughes: 
Gerbode: 


In  the  early  '60s.   Bram  got  some  girls  to  help  him  at  Cutter 
Laboratories.   They  put  the  oxygenator  together  manually  each  day. 
Then  the  whole  problem  of  sterilizing  it  had  to  be  developed,  but 
they  worked  it  all  out.   We  developed  a  prototype  membrane 
oxygenator  after  a  number  of  years,  and  then  I  started  using  it 
clinically.   I  used  it  in  about  three  hundred  cases. 

Can  you  remember  when  you  first  started  to  use  it? 

No,  I  can't  remember.   It  had  to  be  put  together  manually  by  Bram 
and  the  nice  girls  at  Cutter  Laboratories,  and  then  it  had  to  be 
sterilized.   It  was  just  not  very  practical.   However,  it  was  the 
first  membrane  oxygenator  in  the  world  to  be  used  clinically  in  a 
large  group  of  patients. 

How  did  you  come  to  realize  that  the  membrane  was  the  thing? 

Well,  see,  the  disk  oxygenator  was  developed  on  the  principle  of 
exposing  blood  to  oxygen  in  an  open  chamber.   Even  though  people 
use  this  method  in  a  way ,  it  is  pretty  well  shown  that  when  you 
expose  blood  directly  to  oxygen  or  any  other  gas,  it's  not  very 
good  for  the  blood — various  things  happen — whereas  the  membrane 
oxygenator  depends  upon  oxygen  and  C02  diffusing  through  a  membrane, 
so  blood  is  not  directly  exposed  to  any  gases. 

Had  you  found  these  things  out  in  your  own  lab ,  or  was  this  common 
knowledge? 

No,  various  other  people  had  begun  to  find  this  out  as  well. 

Various  Ph.D.s  and  people  working  in  our  laboratory  found  out 
various  ways  of  making  a  membrane  oxygenator  more  satisfactory,  and 
we  even  developed  patents  on  the  way  blood  went  through  it.  We 
finally  sold  our  ideas  to  the  Harvey  Company,  a  subsidiary  of  Bard, 
and  they  spent  about  five  years  on  it  to  develop  a  commercial 
product  that  could  be  sold  easily,  a  disposable  one.   Having  done 
all  that,  they  changed  their  mind  and  decided  to  put  all  their  money 
into  another  type  of  membrane  oxygenator  built  by  Dow  Chemical 
Company . 

Do  you  know  their  thinking? 

I  think  probably  it's  that  they'd  make  more  money  with  the  Dow 
Chemical  one  and  it's  more  feasible  commercially  to  make  it.   So  the 
present  situation  is,  our  membrane  oxygenator  is  sitting  down  in 
Santa  Ana  in  a  laboratory  with  everything  ready  to  go  clinically,  and 
they've  shifted  gears  now  and  are  putting  all  their  production  into 
the  Dow  Chemical  one.   It's  kind  of  a  sad  ending  to  the  whole  story. 


351 


Hughes:   Why  did  you  choose  the  Harvey  Company  in  the  beginning? 

Gerbode:   They  were  very  interested  in  developing  a  membrane  oxygenator,  and 
we  had  the  patents  and  the  concepts. 

Hughes:   We  talked  a  little  about  choosing  patients  for  new  types  of  operations, 
and  you  mentioned  in  connection  with  the  mitral  valvotomies  that 
in  the  beginning  you  were  interested  in  choosing  good  risk  patients, 
mainly  to  keep  the  supply  of  patients  coming.   I  was  wondering  in 
general,  though,  if  you  had  a  policy  about  operating  on  poor  risk 
patients. 

Gerbode:   In  general,  the  cardiologists — and  this  is  not  only  true  in  our 
institute  but  throughout  the  world — would  only  offer  patients  to 
the  surgeon  in  the  beginning  if  the  patients  were  really  desperate. 
This  was  a  hard  hurdle  to  overcome.   We  gradually  got  around  it,  I 
guess,  by  having  good  results  with  the  patients  we  did  do,  and 
bringing  some  pretty  desperate  cases  through.   But  as  I  mentioned 
before,  one  of  the  ways  of  getting  around  the  skeptical  cardiologists 
was  to  have  the  patients  that  were  referred  come  directly  on  the 
surgical  ward ,  and  I  skillfully  arranged  to  do  that  as  much  as 
possible.   Then  I  would  pick  the  cardiologist  who  was  most  surgically 
minded  to  see  the  patient  and  bypass  the  skeptical  ones.   Then 
eventually  the  skeptical  ones  had  to  come  on  the  bandwagon,  too. 

Hughes:   What  do  you  think  was  the  deciding  point  when  a  patient  wasn't  a 
very  good  risk?  I'm  thinking  on  one  hand  of  the  consideration  of 
what  you  might  be  able  to  do  for  the  patient,  and  on  the  other  hand 
what  the  outcome  of  the  operation  might  have  on  the  statistics  of 
a  new  procedure. 

Gerbode:   Of  course,  everything  changed  as  soon  as  we  got  the  heart-lung 
machine  and  started  doing  a  lot  of  open  mitral  operations.  We 
then. could  see  the  valve,  and  then  later  on  got  artificial  valves 
which  could  be  used  to  replace  the  diseased  valve,  and  that  made 
the  picture  quite  different.   Now  there  are  very  few  cardiologists 
who  would  not  allow  the  surgeon  to  try  to  repair  a  diseased  valve 
in  a  very  sick  patient,  because  the  results  are  overwhelmingly  so 
much  better  with  surgery  than  they  are  with  medicine. 

Hughes:    In  the  beginning  when  this  procedure  was  still  very  experimental, 
there  must  have  been  a  lot  of  gray  areas  where  you  weren't  really 
sure  that  you  could  benefit  the  patient  or,  for  that  matter,  the 
future  of  the  procedure. 


352 


Gerbode:   Yes,  it  was  a  very  complex  situation,  and  I  guess  in  the  long  run 
it  depended  on  what  the  surgeon's  mortality  rate  was  in  those  days 
and  how  his  patients  did  afterwards.   If  the  mortality  rate 
consistently  wasn't  so  great,  and  generally  speaking  the  patients 
were  better,  then  more  patients  would  come  for  operations. 

Hughes:   As  simple  as  that. 


Counseling  Patients 


Hughes : 
Gerbode: 

Hughes: 
Gerbode: 


I  know  you  are  against  smoking, 
the  anti-smoking  campaign? 


Have  you  ever  played  any  role  in 


Hughes: 


I  support  any  anti-smoking  organization  that  comes  along  and  asks 
me  for  support,  because  I  think  it's  terribly  important. 

What  about  counseling  patients? 

Well,  I  used  almost  to  refuse  to  operate  upon  patients  who  were  still 
heavy  smokers.   I  wouldn't  actually  turn  them  down,  but  I'd  make  it 
very  difficult  for  them  to  have  the  operation  without  quitting, 
because  it  makes  a  lot  of  difference.   Bad  mitral  patients  who  are 
heavy  smokers  Have  a  much  harder  time  getting  through  the  operation. 
The  respirator  has  to  be  used  for  a  longer  period  of  time,  and  they 
require  a  lot  more  care.   So  I  would  point  this  out  to  them  and 
tell  them,  "If  you  want  to  get  through  this  operation  more  easily, 
you'd  better  stop  smoking  for  a  month  or  so  so  your  lungs  get  a 
chance  to  improve  a  little  anyway."  To  get  some  of  the  women  who 
were  smokers  to  stop,  I'd  use  various  tricks.   One  thing  I  used  to 
tell  the  women  who  were  smokers  and  had  serious  heart  disease ,  "You 
don't  mind  smelling  like  a  man,  do  you?"  And  the  woman  would  say, 
"I  don't  smell  like  a  man."  I  said,  "You  certainly  do,  and  if  you 
want  people  to  like  you,  you  shouldn't  want  to  smell  like  a  man." 
Sometimes  vanity  would  overcome  her  desire  to  smoke,  and  she'd 
change.   [laughter] 

What  about  other  aspects  of  heart  disease,  such  as  diet  and  drinking 
and  tension?  Were  those  things  that  you'd  talk  to  your  patients 
about  as  well? 


353 


Aortocoronary  Bypass  Operations 


Gerbode:   Obesity  is  one  of  the  things  that  we  had  trouble  with  in  some 
patients.   But  actually  arteriosclerosis  came  into  prominence 
because  of  coronary  disease,  and  so  when  AC  bypass  (aortocoronary 
bypass)  techniques  were  developed,  it  was  quite  apparent  that 
arteriosclerosis  was  a  very  important  part  of  heart  disease.   I 
elected  not  to  do  this  operation  because  I  found  it  kind  of  a 
monotonous  procedure.   So  I  turned  it  over  to  my  associates.   It 
has  two  aspects  that  are  very  good.   One  is  that  most  of  the 
patients  are  relieved  of  their  anginal  pain,  and  the  surgeons 
are  better  off  financially  because  it  pays  very  well. 

Hughes:   Why  is  that? 

Gerbode:   The  fees  in  the  beginning  were  set  pretty  high  because  the  procedure 
was  new. 

Hughes:   Why  is  that  particular  procedure  more  monotonous  than  others. 

Gerbode:   It's  just  taking  a  vein  out  of  the  leg  and  sewing  it  onto  the 

heart.   It's  not  inside  the  heart.   There's  no  physiology  connected 
with  it.   It's  just  mechanical,  transferring  the  vein  to  the  outside 
of  the  heart. 


Keeping  Patients  Alive  at  Any  Cost 


Hughes:   Dwight  Harken,  another  cardiac  surgeon,  has  written  in  reference  to 
Barnard's  all-out  efforts  to  keep  Louis  Washkanski,  his  first 
heart  transplant  patient,  alive  despite  pneumonia  and  heart  failure 
and  all  kinds  of  things,  that  Barnard  was  obligated  to  do  anything 
he  could  to  save  his  patient.   What  is  your  philosophy  about  keeping 
patients  alive  at  any  cost? 

Gerbode:   I  guess  I've  always  felt  that  if  I  could  do  something  that  would 

make  the  patient  who  was  desperately  ill  more  comfortable  and  perhaps 
prolong  his  life  a  bit,  it  was  my  duty  to  do  it.   There  are  situations 
where  we  are  keeping  people  alive  when  we  know  that  there's  no 
possibility  of  making  their  life  better,  and  it's  a  terrible  drain 
financially  and  emotionally  on  the  family.   In  those  situations  I 
agree  with  what  has  been  recently  stated  as  a  position  that  we 
should  let  the  patient  decide  whether  he  wants  to  be  kept  alive  any 
longer  or  not.  Some  people  have  said  if  they  got  a  cancer  or  something 
that  was  not  curable,  they  didn't  want  to  be  kept  alive,  and  I  think 
we  should  believe  in  what  they  say. 


354 


Hughes:   The  government  doesn't  seem  to  be  moving  in  that  direction. 
Gerbode:   I  don't  think  the  government's  influencing  this  so  terribly  much. 
Hughes:   I'm  thinking  of  the  Baby  Doe  case.* 

Gerbode:   Well,  there,  you  see,  the  government  has  taken  a  position  because 
there  is  treatment  available,  and  therefore  it  feels  [the  hospital] 
should  apply  the  treatment.   But  there  are  certain  congenital 
abnormalities  in  children  [in  which]  I  think  palliative  procedures 
should  not  be  applied.   It  only  prolongs  the  agony;  really  it's 
not  very  good. 

Hughes:   I  understand  that  the  United  States  has  a  much  more  liberal  attitude 
toward  medical  intervention  than  Britain,  for  example. 

Gerbode:   I  don't  have  any  figures  on  this,  but  I  think  that  probably  we  keep 
trying  harder  and  longer  in  some  of  these  situations  than  other 
countries  do. 

Hughes:   Do  you  think  that  might  change  with  the  great  emphasis  on  keeping 
medical  costs  down? 

Gerbode:   [chuckles]   I  suppose  we  might  get  to  the  point  where  the  government 
or  insurance  companies  would  say,  "We're  not  going  to  pay  for 
treatment  in  this  kind  of  a  patient." 


Heart  Transplantation  Programs 


Hughes:   Blue  Shield  of  California  has  recently  decided  to  cover  heart  and 
heart-lung  transplants  for  its  1.3  million  policyholders  in 
California  as  long  as  procedures  are  performed  at  Stanford  University 
Medical  Center. 

Gerbode:   I  was  at  the  meeting  where  this  was  decided,  and  voted  in  favor  of 
it  as  a  consultant. 

Hughes:   Can  you  tell  me  why? 


*The  Baby  Doe  case,  which  occurred  in  1984,  concerned  a  baby  born 
with  severe  congenital  anomalies.  Against  the  parents'  wishes,  the 
government  required  the  hospital  to  use  extraordinary  measures  to 
keep  the  baby  alive. 


355 


Gerbode:  They  have  the  best  record,  and  I  think  to  keep  the  confidence  in 
the  procedure  at  the  proper  level,  those  who  can  do  the  job  very 
well  should  be  permitted  to  do  it  with  compensation. 

Hughes:    So  it  really  does  boil  down  to  a  matter  of  statistics? 

Gerbode:   Yes.   Eventually,  as  other  units  demonstrate  that  they  can  do  the 
procedure  with  a  very  low  mortality  rate,  then  I  think  Blue  Shield 
will  pay  for  them. 

Hughes:   Why  was  Blue  Shield  prompted  to  make  this  policy  decision? 

Gerbode:  I  guess  because  some  of  these  families  have  Blue  Shield  insurance, 
and  unless  they  have  the  insurance  money  to  help  pay  for  the  bill, 
it  is  too  hard  on  them  financially. 

Hughes:  Why  would  an  insurance  company  take  on  this  potentially  tremendous 
expense? 

Gerbode:   It's  not  such  a  big  thing,  because  there  aren't  hearts  available 

in  volume  to  make  it  very  much  of  a  burden  on  the  insurance  company. 
Patients  have  to  be  carefully  selected.   [They  have  to  be]  in  a 
certain  age  group  with  a  certain  type  of  disease.   That  eliminates 
a  great  many  people  right  away.   Then  you  have  to  find  a  donor  that 
will  be  satisfactory  for  that  particular  recipient.   That  immediately 
cuts  down  the  number.   It's  not  like  mitral  stenosis  or  a  patent 
ductus  or  something  like  that.   There  are  all  these  limiting 
factors  that  cut  down  on  the  volume  [of  heart  transplant  cases]. 

Hughes:   Was  it  just  sheerly  numbers  of  policyholders  that  wanted  this  coverage 
that  caused  Blue  Shield  to  consider  covering  heart-lung  transplants? 

Gerbode:   I  suppose  the  number  of  families  that  have  Blue  Shield  insurance, 
even  if  there  weren't  very  many  of  them,  who  wanted  to  have  their 
insurance  apply  to  this  procedure,  would  influence  that  decision. 
But  also  Stanford  probably  applied  for  permission  to  have  Blue 
Shield  pay  for  it.   I  don't  think  anybody  else  applied. 

Hughes:    Isn't  there  a  danger  that  this  will  hold  back  other  [heart  transplant] 
programs,  including  the  one  at  the  Pacific  Medical  Center? 

Gerbode:   I  think  it  will.   It  will  certainly  limit  the  ones  who  are  trying 
to  get  in  without  too  much  ability  and  background. 

#1 

Gerbode:   However,  in  time  other  units  will  develop  their  techniques  to  the 
point  where  their  results  will  be  equally  good  [as  Stanford's]  and 
then  they'll  want  to  be  paid  as  well. 


356 


Hughes:    I  can  see  that  an  insurance  company  stepping  in  at  an  early  stage 
in  the  procedure  could  very  much  influence  which  centers  succeed 
and  which  don't,  at  least  for  the  immediate  future. 

Gerbode:   Yes,  that's  true. 

Hughes:   Was  any  of  this  considered  when  the  Pacific  Medical  Center  decided 
to  start  a  transplant  program? 

Gerbode:   It  was  always  considered,  because  the  trustees,  of  which  I  was 
one,  had  to  vote  in  favor  of  doing  it  even  though  we  might  lose 
money . 

Hughes:   Why  did  you  make  that  decision? 

Gerbode:   Because  we  think  it's  something  that's  in  our  realm  of  capability. 

Hughes:   And  that  would  override  the  financial  considerations? 

Gerbode:  Yes,  I  think  so.   I  think  some  institutions  can  afford  to  do  this 
and  some  can't. 

Hughes:   Did  you  know  that  the  Blue  Shield  business  was  coming  up  when  you 
made  the  decision  to  have  the  program  here? 

Gerbode:  No. 

Hughes:   Do  you  think  your  decision  would  have  been  different  if  you  had 
known? 

Gerbode:   I  don't  think  so.   Blue  Shield  knew  that  we  had  a  successful  case 
and  were  going  to  continue  to  do  cases.   I  was  on  the  advisory 
committee — I  think  we  all  felt  that  eventually  other  units  would 
have  enough  experience  so  that  they  would  be  paid  as  well. 

Hughes:    Given  the  fact  that  there  aren't  very  many  patients  in  this  area 
needing  that  kind  of  operation,  why  do  you  need  [heart  transplant] 
units  at  different  centers? 

Gerbode:   [pause]  You  don't  need  very  many,  but  you  need  more  than  one. 
Hughes:   Is  that  just  the  spirit  of  competition? 

Gerbode:   I  think  it's  better  to  have  more  than  one;  competition  enters  into 
it.   I  think  if  two  units  are  trying  to  do  a  certain  procedure, 
they're  certainly  going  to  keep  their  techniques  sharp. 


357 


Etiology 


Hughes:   Medicine  has  been  called  a  practical  art  rather  than  an  applied 
science,  because  in  general  its  primary  aim  is  to  cure  disease. 
In  many  cases  there  is  little  concern  to  understand  the  mechanism 
of  cure  or  even  the  cause  of  the  disease.   Do  you  agree  that 
medicine  really  has  this  orientation? 

Gerbode:   No,  I  don't  agree  with  that  at  all.   I  think  the  physician  and  the 
surgeon  are  very  interested  in  what  causes  the  disease  and  to 
understand  the  mechanism  of  what  caused  it. 

Hughes:    Is  that  intellectual  curiosity? 

Gerbode:   No,  it's  not  intellectual  curiosity.   I  think  it's  being  intelligent. 
We  can't  understand  all  the  mechanisms  that  produce  the  congential 
heart  lesion  in  a  baby,  but  we've  made  a  great  many  inroads  into 
understanding  how  it  happens.   For  example,  German  measles  in  the 
mother  has  been  found  out  through  the  medical  profession  to  be  a 
cause  of  congenital  heart  disease  in  babies.   Doctors  are  curious 
to  know  why  certain  types  of  severe  influenza  in  the  first  trimester 
would  be  a  cause  of  congenital  defects.   We  don't  understand  the 
actual  intrauterine  event  that  causes  this  thing,  but  some  people  are 
veiy  curious  about  it.   We're  very  curious  to  know  why  mitral  valve 
disease  has  occurred,  and  we  find  that  it's  due  mainly  to  rheumatic 
fever,  and  that  rheumatic  fever  is  caused  by  a  streptococcus.   We 
teach  families  to  give  their  children  antibiotics  when  they  have 
streptococcal  infections.   I  don't  think  I  fully  understand  your 
question. 

Hughes:   You  answered  it  more  or  less. 

Gerbode:   I  think  also  doctors  are  very  good  about  suggesting  abortions  in 
women  who  have  had  German  measles  or  some  severe  illness  in  the 
first  trimester.   That's  due  to  the  understanding  that  the  incidence 
of  having  a  child  with  a  congenital  abnormality  is  much  higher 
than  in  a  woman  without  this  sort  of  medical  background.   We're  a 
lot  more  interested  in  cause  [and  prevention]  than  we  are  in  getting 
that  child  for  a  corrective  operation. 

Hughes:   What  you  were  doing  in  the  dog  lab  wat  very  directly  tied  in  with 
what  you  were  hoping  to  do  in  the  operating  room,  but  do  you  think 
that's  pretty  much  true  across  the  board  in  all  the  areas  of 
research  at  HRI?   Is  the  ultimate  aim  patient  application,  or  is 
that  link  sometimes  not  quite  so  direct? 


358 


Gerbode:   I  think  the  ultimate  aim  is  to  understand  disease  better  and  prevent 
it  or  cure  it.   There's  another  whole  moral  aspect  of  this  thing 
that  worried  me  in  the  beginning,  of  being  able  to  operate  upon  all 
these  children  with  congenital  heart  disease,  particularly  the  blue 
babies  with  severe  congenital  abnormalities.   I  worried  for  a  little 
while,  not  very  long,  whether  it  was  right  to  keep  those  children  in 
circulation,  because  the  incidence  of  congenital  heart  disease  in 
those  children  who  marry  and  have  babies  is  higher.   But  then  I  said 
to  myself,  "I'm  being  God  if  I  do  that.   I  can't  take  that  attitude. 
If  there  is  a  good  treatment  available  we  should  use  it." 


Setting  and  Controlling  Medical  and  Surgical  Fees* 
[Interview  15:  May  15,  1984 ]## 

Hughes:   I  was  wondering  how  you  establish  fees  for  operations. 

Gerbode:   Fees  are  established  by  custom  and  also  by  a  schedule  which  is 

called  the  California  Relative  Value  Scale.   Each  operation  has  a 
certain  number  of  units  connected  with  it.  A  big  operation  would 
have  more  units  than  a  smaller  operation.   Then  you  apply  the  basic 
fee  for  one  unit  to  that  and  multiply  it  by  the  number  assigned  to 
that  particular  procedure.   However,  it's  been  customary  in  California 
for  heart  surgeons  not  necessarily  to  obey  that  mode  of  charging 
patients.   Some  of  them,  unfortunately,  have  been  charging  rather 
large  fees  which  I  think  has  been  very  bad  for  the  speciality  as  a 
whole. 

The  relative  value  scale  in  California  was  adopted  by  various 
specialities,  and  then  later  was  used  by  insurance  companies  and 
units  in  other  states  as  a  basic  groundwork  for  charging  for  the  work 
done.   I  helped  put  together  the  first  relative  value  scale  for 
cardiovascular  and  vascular  work  in  this  state  with  a  committee  for 
which  I  was  chairman. 

Hughes:   What  sort  of  criteria  were  you  using  to  establish  the  fees? 

Gerbode:  Well,  we  just  decided  if,  for  example,  an  appendectomy  was  worth  this 
number  of  units,  a  cardiovascular  procedure  would  be  maybe  twice  as 
complicated  and  you  would  use  twice  the  number  of  units. 


*See  the  session  recorded  on  6/21/84,  pp.  429-430. 


359 


Hughes:   What  is  a  unit  based  on? 

Gerbode:   A  unit  is  based  on  what  surgeons  have  been  charging  over  a  short 
period  of  time  before  the  unit  was  established. 

Hughes:    So  it's  a  matter  of  time  and  the  difficulty  of  the  operation? 

Gerbode:   Yes. 

Hughes:   Anything  else? 

Gerbode:   I  guess  the  rarity  and  difficulty  of  a  procedure  has  something  to  do 
with  it.   If  there  has  been  a  complication,  this  adds  something  to 
it  as  well.   It's  been  working  in  this  form  more  or  less  for  quite 
a  while  and  I  think  that  some  of  the  insurance  companies  simply 
call  a  procedure  by  a  given  name  and  they  pay  just  that  amount  for 
the  procedure  to  be  done. 

Hughes:   When  you  say  quite  a  while,  do  you  mean  after  World  War  II? 
Gerbode:   Oh  yes.   This  is  all  in  the  last  ten  or  fifteen  years. 
Hughes:   How  were  fees  determined  before  then? 

Gerbode:   I  guess  surgeons  just  charged  whatever  they  felt  their  contemporaries 
were  charging  in  the  same  field. 

Hughes:    So  the  same  operation  in  different  parts  of  the  country  could  be 
quite  a  different  price? 

Gerbode:   Yes,  that's  true.   They  would  charge  more  on  the  East  Coast  than 
on  the  West  Coast,  for  example. 

Hughes:   Why  don't  heart  surgeons  hold  to  these  conventions? 

Gerbode:   In  general,  they  stick  pretty  close  to  the  convention,  but  there 

are  a  few  who  take  advantage  of  the  situation  and  charge  a  lot  more. 

Hughes:   Not  necessarily  those  who  are  prominent  in  the  field? 

Gerbode:   These  are  all  good  surgeons,  but  they  just  have  a  different  attitude 
about  how  much  they  should  charge. 

Hughes:   Do  you  find  that  patients  nowadays  are  shopping  around  much  more? 

Gerbode:   Yes.   They  are  much  more  knowledgeable  about  fees  too,  and  they're 
more  apt  to  ask  in  advance  what  the  fee  is  going  to  be ,  which  is 
very  good.   I  always  told  patients  the  bracket  within  which  the 
charge  would  fall  and  would  be  sure  to  stay  within  that  bracket. 


360 


Hughes:   Are  you  talking  just  about  the  surgery  or  about  the  preop  and 
postop  care  as  well? 

Gerbode:  Well,  if  we  were  going  to  operate  upon  a  patient,  we  wouldn't  charge 
anything  for  the  preoperative  visits  nor  for  the  postoperative 
visits  for  a  year.   It's  all  a  one-packaged  deal.   That's  not  true 
for  the  cardiologists,  however.  They  charge  for  everything. 

Hughes:   The  anesthesiologist,  of  course,  would  be  another  fee,  wouldn't  it? 

Gerbode:  Yes,  anesthesiologists  earn  more  money  in  the  United  States  than  any 
other  group  of  physicians. 

Hughes:   Why  do  you  think  that  is? 
Gerbode:   I  don't  know  why,  but  it's  true. 
Hughes:   Anything  else  about  establishing  fees? 

Gerbode:   The  whole  business  of  payment  for  operations  with  Medicare  is  very 
shortly  going  to  undergo  a  great  revolution.   I  think  what's  going 
to  happen  is  that  the  medical  profession  will  be  told  that  it's 
only  going  to  get  a  certain  amount  per  operation. 

Hughes:   Regardless  where  it's  done? 

Gerbode:   Regardless;  the  idea  being  that  the  easy  operations  would  sort  of 
smooth  over  the  tough  ones  and  even  it  up  more  or  less.   If  the 
hospital  hires  surgeons  as  they  are  trying  very  desperately  to  do 
in  Australia — it's  still  against  the  law  here — then  they'll  begin 
to  set  the  fees  for  the  surgeons  they've  hired. 

One  administrator  in  Australia  felt  that  if  the  hospital  hired 
a  surgeon,  that  he  should  charge  no  more  than  forty-five  dollars  an 
hour  for  his  surgery. 

Hughes:   Regardless. 

Gerbode:   Regardless.  Now,  if  you  can  imagine  what  uproar  this  occasioned 

in  Australia — I  don't  think  they  have  a  chance  of  it  getting  through- 
but  that's  the  thinking  of  the  administrators. 

Hughes:   How  would  an  average  fee  be  determined  in  this  country? 

Gerbode:  Well,  to  begin  with,  you  use  that  relative  value  scale  and  then 

surgeons  have  been  charging  a  certain  fee  for  certain  operations  for 
quite  a  while,  so  they  could  average  those  out.   The  pay  for  an 


361 


Gerbode:   AC  [aortocoronary]  bypass,  for  example,  would  be  determined  by 

how  much  was  being  charged  by  the  average  surgeon  for  an  AC  bypass 
operation. 

Hughes:   Do  you  think  that  will  ultimately  affect  the  distribution  of  surgeons 
in  this  country? 

Gerbode:   If  you're  asking  what  effect  control  of  fees,  perhaps  through 

hospitals,  will  have,  it'll  cut  down  on  the  number  of  hospitals  and 
doctors  that  are  doing  that  work.   Most  cardiac  surgeons  are  not 
overwhelmed  with  cases.   Some  are,  but  most  of  them  aren't.   So 
that  means  we  have  a  relative  surplus  of  cardiac  surgeons.  That 
means  that  this  [control  of  fees]  opens  the  door  for  competition, 
and  eventually  that's  going  to  occur. 

Hughes:   Do  you  think  that  will  be  fought  by  the  AMA  and  other  medical 
organizations? 

Gerbode:   Well,  it  depends  on  how  they  do  it.   I  think  the  business  of 

hospitals  hiring  doctors  to  do  the  work  is  going  to  be  fought  very 
strenuously. 

Hughes:   Because  of  the  fee-setting  policy? 

Gerbode:   Yes,  and  also  you  would  get  administrators  running  the  doctors,  which 
is  not  what  they  like  very  much. 

Hughes:    I  imagine  this  will  be  one  of  the  things  that  you'll  be  discussing 
at  the  National  Academy  of  Medical  Specialities.* 

Gerbode:   Oh,  I  think  that'll  be  one  of  the  things  under  consideration  all 
right.   Only  I  think  fees  in  general  will  be  considered,  too,  and 
how  to  establish  a  fee. 

Hughes:   How  well  is  this  voluntary  moratorium  on  fee  increases  working? 

Gerbode:   I  think  it's  working  all  right. 

Hughes:   Do  you  think  it  could  be  kept  on  a  voluntary  basis? 

Gerbode:   I  think  as  long  as  it's  working  all  right,  it  should  be.   What  so 

often  happens  with  voluntary  things  is  that  some  people  begin  to  break 
the  voluntary  rules  and  then  it  becomes  a  free-for-all  again. 


*The  Academy,  formed  of  prominent  representatives  of  the  medical 
specialities,  was  established  by  Congress  in  1984  to  advise  the 
federal  government  on  current  medical  problems.   Dr.  Gerbode  accepted 
the  co-chairmanship  of  the  section  on  medicine  in  March  1984.   He  died 
before  the  first  formal  meeting  of  the  Academy  in  1985. 


362 


Artificial  Heart  Valves 


Hughes : 


Gerbode ; 


Hughes : 
Gerbode: 
Hughes: 
Gerbode: 


Hughes : 


Gerbode: 


Hughes: 
Gerbode: 
Hughes : 

Gerbode: 


I  was  reading  some  correspondance  written  in  1973  with  Viking  Bj6rk 
about  the  use  of  artificial  heart  valves  and  he  was  wondering  if  you 
were  using  his  disk  valve.  You  wrote  back  saying  something  to  the 
effect  that  you  had  been  using  the  Edwards  and  Cutter  valves.   I 
was  wondering  why  you  selected  certain  valves  over  others. 

I  hadn't  seen  very  many  patients  with  Viking's  disk  valve.   But 
I  had  seen  a  fair  number  of  patients  with  the  first  Cutter  valve,  not 
the  cloth-covered  one  which  proved  to  be  a  disaster.   We  very  early 
took  on  tissue  valves  made  out  of  the  pig's  aortic  valve  and  treated 
with  glutaraldehyde. 

You  mean  in  preference  to  the  artificial  valve? 
Yes. 

Why? 

Well,  because  the  incidence  of  thromboembolic  complications  was 
virtually  zero  with  tissue  valves,  whereas  it  was  still  appreciable 
with  mechanical  valves.   Patients  on  mechanical  valves  had  to  have 
cumadin,  a  blood  thinning  drug,  and  this  in  itself  can  produce 
complications.   I  remember  having  seen  two  patients  come  in  after 
having  a  mechanical  valve  installed  and  being  placed  on  cumadin 
and  dying  of  brain  hemorrhage. 

You  said  in  this  same  letter  that  you  preferred  not  to  use  any  anti 
coagulants. 

Now  we've  seen  that  the  complication  rate  for  tissue  valves  is  lower 
than  it  has  been  for  mechanical  valves.   But  the  tissue  valves  are 
now  showing  a  certain  amount  of  failure  after  five  to  ten  years. 
So  you  have  to  weigh  that  against  the  disadvantages  [of  the  mechanical 
valves] . 

You  mean  they  simply  wear  out? 
Yes,  or  get  calcified. 

Is  the  greater  frequency  of  embolism  with  the  artificial  valve  just 
because  it  is  an  artificial  substance? 

Yes,  it's  a  metallic  substance  and  it 's  more  foreign  than  a  tissue 
valve,  you  might  say. 


363 


Hughes:   Were  you  unusual  in  not  using  anticoagulants  with  artificial  valves? 

Gerbode:   No,  but  if  we  used  the  mechanical  valve,  we  had  to  use  anticoagulants 
because  it  proved  to  be  statistically  better  to  do  so  even  though 
there  are  problems  with  giving  patients  cumadin.   The  problems  with 
not  using  cumadin  are  greater.   There  are  a  certain  number  of 
patients  who  bleed  with  cumadin,  too.   They  [may]  get  massive 
hemorrhage  in  their  gut  or  if  they  get  a  bad  bruise  somewhere  it  is 
apt  to  grow  into  a  big  hematoma. 

Hughes:   You've  never  had  to  use  anticoagulants  with  the  pig  valves? 

Gerbode:   Well,  some  people  felt  they  had  to  use  anticoagulants  in  the  mitral 
area  because  there  was  a  small  instance  of  thromboembolism.   But 
some  people  still  didn't  use  anticoagulants  even  though  there  was  a 
small  incidence  of  thromboembolic  complications. 

Hughes:   Why  should  there  be  more  incidence  at  the  mitral  valve? 

Gerbode:  Because  the  flow  of  blood  is  slower  and  not  as  vigorous.  There  is 
more  chance  of  little  thrombi  forming  on  the  rim  of  the  valve. 

Hughes:   Bjork  said  in  this  correspondance  that  he  always  used  cumadin 
because  that  was  what  was  commonly  used  in  Sweden. 

Gerbode:  He  used  cumadin  from  the  very  beginning,  and  so  did  Starr  with  his 
valve,  and  so  did  the  so-called  Sacramento  valve  people,  and  later 
on  others  who  developed  mechanical  valves  used  anticoagulants,  too. 

Hughes:   Well,  when  you  used  the  Starr  valve,  would  you  use  anticoagulants 
as  well? 

Gerbode:   Yes.   We've  put  a  lot  of  Starr  valves  in  and  we  used  anticoagulants 
in  all  of  them. 

Hughes:   Which  did  you  think  was  the  best? 

Gerbode:   I  thought  the  Starr  valve  was  the  best  when  we  first  started,  because 
I  really  didn't  know  too  much  about  Viking's  valve.   But  now,  having 
looked  back  at  the  whole  thing,  I  think  Viking's  valve  has  a  slight 
advantage  over  the  others. 

Hughes:   Which  is  what? 

Gerbode:   Well,  there  are  fewer  complications  with  the  mechanical  aspects 

of  the  valve,  and  I  think  it  just  works  better  for  a  longer  period 
of  time. 


364 


Hughes:   Was  it  widely  used  in  this  country? 
Gerbode:  Oh  yes!  Thousands  have  been  put  in. 

Hughes:   You  said  in  this  letter  that  you  hadn't  used  it  very  much,  but  it 
would  be  the  valve  of  preference  in  children  with  a  very  narrow 
aortic  root. 

Gerbode:  Yes,  that's  true. 
Hughes:   Why  would  that  be? 

Gerbode:  The  orifice  size  for  the  ring  which  you  have  to  use  to  hold  the 
valve  is  bigger  than  some  of  the  others. 

Hughes:   You  said  just  a  minute  ago  that  the  cloth-covered  Cutter  valve  was 
a  disaster.  Why? 

Gerbode:  Well,  Dr.  [Nina]  Braunwald,  who  had  suggested  this  from  a  rather 
limited  number  of  dog  experiments,  thought  that  fewer  thromboses 
occurred  when  the  ring  was  covered  with  cloth.   She  thought  the 
tissue  would  grow  into  it  and  make  it  more  like  natural  tissue.   But 
actually  what  happened  was  that  it "just  formed  a  great  nidus  for 
clots.   So  everybody  finally  gave  up  on  that,  and  I'm  afraid  that 
Nina  Braumwald's  reputation  has  suffered  quite  a  good  deal  as  a 
consequence. 

Hughes:   Was  she  a  local  person? 

Gerbode:  No,  she  was  in  Boston.  Her  husband  is  professor  of  medicine  at 
Harvard.   She  was  a  heart  surgeon  trained  at  the  United  States 
Public  Health  Hospital  in  Bethesda. 

Hughes:   Isn't  she  one  of  the  few  women  to  go  into  heart  surgery? 

Gerbode:  Very  few  women. 

Hughes:   Why  do  you  think  that  is? 

Gerbode:   It's  a  tough  life  (both  laugh).   I  saw  a  couple  of  them  in  Russia 

who  were  doing  very  well.   Some  of  the  Russian  female  heart  surgeons 
are  pretty  good. 

Hughes:   You  mean  technically  good.  Were  they  accepted  by  their  male 
colleagues? 

Gerbode:  Yes,  because  they're  tough. 


365 


Extrapolation  from  Animal  Research  to  Operations  on  Humans 


Hughes:    I  was  reading  an  article  written  in  1969  by  Francis  Moore  and  he 

said  that  it's  impossible  to  reproduce  chronic  valvular  disease  or 
congenital  heart  disease  in  a  dog. 

Gerbode:   Well,  I  think  it's  impossible  to  make  it  identical  with  what  occurs 
in  nature. 

Hughes:    So  it's  the  fact  that  it's  experimentally  produced.   It's  not  that 
the  dog  is  not  susceptible. 

Gerbode:   It's  technically  too  difficult  to  do  it  and  have  it  exactly  like 
it  is  in  the  human. 

Hughes:    I  would  think  this  would  make  a  difference  when  you  made  the  great 
leap  from  the  dog  lab  into  the  operating  room.   Were  surgeons  in 
general  pretty  well  aware  that  what  they  had  been  doing  and  seeing 
in  the  dog  might  not  be  replicated  in  the  human? 

Gerbode:   Generally  speaking,  when  a  surgeon  first  looks  into  a  beating  human 

heart  and  contemplates  an  open  heart  operation  on  that  heart,  I  think 
he  really  can  be  very  confused  with  the  appearance  of  it.   Most  of 
our  knowledge  about  hearts  and  how  they  look  and  what  went  wrong 
are  based  on  pickled  specimens.   They're  kind  of  shrunken  and  hard, 
whereas  the  living  heart  is  soft  and  pliable  and  quite  different 
looking. 

Hughes:  Yet  you,  who  have  done  so  much  work  in  the  dog  lab,  wouldn't  have 
had  that  problem.  The  living  beating  dog  heart  doesn't  look  that  . 
different  from  the  human. 

Gerbode:   No,  it  looks  like  a  human  heart.   Well,  we  did  experiments  on  the 
dog  simulating  what  we  thought  would  be  necessary.   Sometimes  we 
put  in  an  artificial  valve,  for  example.   You  just  take  out  a 
normal  valve  and  put  an  artificial  one  in,  or  create  an  atrial 
septal  defect  and  then  repair  it. 

Hughes:   Did  you  find  that  in  most  cases  what  you  had  done  with  the  dog  held 
very  true  for  what  you  found  in  the  human? 

Gerbode:   Oh  yes. 


366 


Consent  Forms 


Hughes : 
Gerbode: 

Hughes: 
Gerbode: 
Hughes : 
Gerbode: 


Hughes: 
Gerbode: 

Hughes: 

Gerbode: 
Hughes: 
Gerbode: 
Hughes: 

Gerbode: 


Do  you  remember  if  patient  consent  forms  were  always — 

In  the  beginning  we  had  no  consent  forms  especially  designed  for 
heart  surgery. 

Were  there  consent  forms  of  some  kind? 

Yes,  there  were.   There  was  always  an  operative  consent  form. 

This  is  going  way  back  to  the  thirties. 

Way  back,  yes.   But  later  on  when  surgeons  began  to  be  sued  very 
freely  and  easily,  we  wrote  another  consent  form  in  which  we  said 
more  or  less.  "My  surgeon  has  explained  all  the  possible  complications 
and  reasons  for  failure  of  the  operation  and  I  understand  the  risk 
very  thoroughly  and  we  don't  hold  him  responsible."  The  words  were 
changed  depending  on  who  wrote  it. 

What  was  the  previous  form  like? 

The  previous  form  was  a  simple  statement  saying  I  hereby  approve  my 
surgeon  to  perform  an  appendectomy  or  whatever  it  was. 

In  both  of  those  cases  it  sounds  to  me  as  though  the  aim  is  really 
to  protect  the  surgeon  and  the  institution  rather  than  the  patient. 
Is  that  not  true? 

I  don't  see  how  a  form  like  that  can  protect  the  patient  during  an 
operation. 

A  form  obviously  can't  prevent  an  operation  from  causing  some  harm, 
but  it  could  give  the  patient  legal  recourse. 


That's  after  the  harm  has  been  done, 
very  much  during  the  operation. 


It  wouldn't  protect  the  patient 


It  seems  to  me  that  the  emphasis  has  shifted  somewhat  so  that  now 
there  is  an  effort  to  look  after  the  patient's  rights  as  well  as 
the  physician's. 

I  always  had  a  conference  with  the  patient  and  his  or  her  spouse. 
I  had  both  of  them  sign  the  consent  form  so  that  they  would  both 
acknowledge  that  I'd  explained  the  operation  rather  thoroughly  to 
them. 


367 


Hughes:   Was  there  ever  any  problem  with  signing  those  consent  forms? 

Gerbode:   Once  or  twice  somebody  wouldn't  want  to  sign  it  for  a  while  and 
we'd  simply  hold  up  the  operation  till  they  made  up  their  mind. 

Hughes:   When  did  lawsuits  really  pick  up? 
Gerbode:   Just  about  ten  years  ago  [1974]. 


Correcting  Septal  Defects 


Hughes:   You  were  correcting  ventricular  septal  defects  successfully  in  1956. 
Could  you  describe  what  you  did  in  those  days? 

Gerbode:   When  you  get  involved  with  doing  congenital  heart  cases,  among  the 
very  first  ones  you  get  are  ventricular  septal  defects.   We  adopted 
our  method  of  closing  ventricular  defects  based  on  what  little 
experience  there  was  elsewhere  and  what  we  thought  would  be  the 
best  way  to  do  it. 

Hughes:   Could  you  describe  it? 

Gerbode:   Most  of  them  could  not  be  closed  directly  with  a  suture  for  various 
reasons,  so  we  used  patches  of  dacron  cloth.   We  cut  a  little  circle 
out,  about  the  size  of  the  defect,  and  sewed  it  in. 

Hughes:   Were  other  people  using  that  technique? 

Gerbode:   They  were  using  that  same  technique  too,  or  trying  others.   But 

most  of  them  quickly  realized  that  they  would  have  to  patch  the  hole 
rather  than  just  try  to  close  it.   There  are  various  ways  of 
entering  the  right  ventricle  to  expose  the  defect.   Mark  Bainbridge, 
working  in  our  laboratory,  decided  that  a  transverse  incision  in  the 
right  ventricle  was  tolerated  better  than  a  verticle  incision  to 
expose  the  VSD.   Mark  is  now  chief  of  cardiovascular  surgery  at 
Saint  Thomas'  Hospital  in  London. 

Hughes:   Why  would  that  be? 

Gerbode:   Because  it's  more  in  the  direction  of  the  fibers  rather  than  cutting 
across  the  fibers.   I  think  a  lot  of  people  have  adopted  that 
incision.   It  also  preserves  more  coronary  vessels. 

Hughes:    Is  that  what  was  referred  to  as  the  Gerbode  technique? 


368 


Gerbode:  Yes.   [laughter] 

Hughes:   I  read  about  a  hook  that  you  apparently  devised  in  connection  with 
these  operations. 

Gerbode:   Before  we  had  an  open  heart  team  and  a  heart-lung  machine  we  had 

a  lot  of  atrial-septal  defects  to  close.   There  were  various  blind 
techniques  being  used  for  closing  the  atrial-septal  defect.  One  of 
them  was  a  Sondergaard  technique.   Sondergaard  is  a  Scandinavian 
surgeon  who  put  a  circular  suture  around  the  defect,  guiding  its 
insertion  from  the  outside  with  his  finger,  and  then  he'd  tie  it, 
pull  it  together.   That  would  close  it.   It  was  like  tying  the  top 
of  a  purse.   That  worked  in  many  cases  but  sometimes  the  suture  would 
loosen  after  a  while  and  the  hole  would  open  again. 

Bob  Gross  devised  a  method  of  making  a  well,  putting  a  sort 
of  funnel  on  top  of  the  heart  with  the  blood  still  in  the  heart 
because  blood  would  only  go  up  to  a  certain  level  in  the  well.   He 
could  sew  through  the  well  and  close  the  defect.   I  tried  it  a  couple 
of  times  but  I  didn't  really  like  it  very  much.   They  tried  it  at 
the  Mayo  Clinic  too. 

I  devised  a  hook;  guiding  the  hook  with  my  left  hand  I  grasped 
the  medial  edge  of  the  defect,  pulled  it  over  to  the  outside  and 
when  it  was  pulled  over  and  held  that  way  I'd  put  a  suture  through 
the  outside  and  engage  it.   I  did  about  thirty  ASDs  that  way.   I 
think  most  of  them  stayed  closed.   It's  not  a  very  good  way.   It's 
so  blind  you  know. 

Hughes:   Yes,  and  having  to  work  fast  too,  I'd  imagine. 

Gerbode:  Not  terribly  fast,  no.   The  main  thing  is  not  to  upset  the  heart  too 
much;  take  your  time  and  not  upset  the  heart. 

Hughes:   In  his  correspondence  with  Bjork,  he  mentioned  forcing  Crafoord 

to  try  this  technique  which  would  have  been  the  mid-1950s.  Why  was 
Crafoord  resistant? 


Gerbode:   I  guess  maybe  he  was  still  influenced  by  Sondergaard. 


369 


Early  Open  Heart  Operations 


Hughes : 


Gerbode: 


Hughes: 
Gerbode : 
Hughes: 
Gerbode: 

Hughes: 
Gerbode: 

Hughes: 
Gerbode: 


Here's  a  letter  which  you  wrote  to  Bjork  in  April  1960.   I'll  read 
one  paragraph:   "We  are  very  busy  using  the  combination  of 
hypothermia  in  extracorporeal  circulation  with  our  new  lung.  And 
since  August  we  have  done  approximately  one  hundred  cases  with  it 
and  have  for  comparison  another  one  hundred  cases  done  during  the 
previous  six  months  using  milder  hypothermia  and  the  Stanford  version 
of  the  Melrose  lung.   The  last  one  hundred  with  the  new  equipment 
seemed  to  have  much  less  reaction  to  the  operation.   One  the  whole, 
the  combination  of  the  two  as  we  are  now  employing  it  seems  to  give 
us  much  more  versatility  and  command  of  the  situation.   This  is 
particularly  true  in  the  more  complicated  lesions.   For  example, 
of  the  nine  consecutive  very  cyanotic  tetralogies  we  have  done 
recently,  we  have  lost  only  one  and  the  other  eight  are  apparently 
completely  cured." 


Was  this  an  unusual  study  for  those  days? 
with  two  hundred  cases  all  told. 


You  were  dealing 


I  think  we  were  all  running  in  the  same  direction  using  slightly 
different  techniques.   I  decided  that  we'd  use  hypothermia  with  the 
heart-lung  machine  because  you  didn't  have  to  use  the  machine  as 
much,  which  was  better,  and  you  could  make  a  heart  drier  with  more 
safety,  and  it.  just  seemed  to  work  better. 

The  machine,  at  that  point,  was  still  pretty  primitive,  wasn't  it? 

Yes,  it  was. 

What  was  the  Stanford  version  of  the  Melrose  lung? 

Melrose  came  over  here  from  England  and  brought  his  machine  with  him. 
He  changed  it  a  bit  after  he  got  it  here.   We  tried  it  on  a  series 
of  patients,  tut  it  was  not  a  very  satisfactory  machine. 

It's  that  slight  modification  that  he  made  while  he  was  here  that 
is  called  the  Stanford  version? 

I've  forgotten  the  details  of  that  now.   I  don't  quite  remember  what 
he  did  about  that.   But  it  was  too  much  like  a  washing  machine.   It 
damaged  the  blood  far  too  much. 

So  you  went  back  to  your  disk  oxygenator. 
Yes. 


370 


Hughes:   Why  did  you  say  that  the  combination  of  hypothermia  and  extracorporeal 
circulation  gave  you  more  versatility  and  command  of  the  situation? 

Gerbode:   First  of  all,  you  don't  have  to  pump  as  much  blood.   The  less  that 
blood  goes  through  that  machine,  the  less  trauma  there  is  to  it. 
You  could  work  under  lower  blood  pressure  and  this  is  easier  too. 
The  patient  can  tolerate  that  lower  blood  pressure  much  better  if 
there's  hypothermia  with  it. 

Hughes:   How  were  you  determining  the  level  of  hypothermia? 

Gerbode:  We  just  arbitrarily  decided  that  it  would  be  a  certain  level  which 
was  about  32°,  about  5°  lower  than  normal.*  I  guess  we  found  if  we 
went  much  lower  that,  we'd  get  in  more  trouble  from  the  hypothermia 
and  if  we  went  higher  than  that,  it  wasn't  much  use. 


Postoperative  Problems  After  Open  Heart  Surgery 


Hughes:   Do  you  remember  what  the  main  problems  in  those  days  were  post- 
operatively?  This  was  1960. 

Gerbode:   I  think  the  main  problems  were  associated  with  postoperative  pulmonary 
problems,  and  they  had  to  do  with  trauma  to  the  blood  as  it  went 
through  the  machines.   We  weren't  using  blood  filtration  in  those 
days  and  so  there  was  a  lot  of  debris  that  went  through  the  machine 
and  got  into  the  patient's  lungs  and  that  produced,  they  call  it, 
the  pump-lung  syndrome . 

A  lot  of  people  didn't  realize  what  the  pump-lung  syndrome  was 
until  we  began  to  study  the  blood  after  it  went  through  the  heart- 
lung  machine.  We  found  platelet  debris  and  little  bits  of  thrombi 
and  sometimes  a  little  bit  of  the  tubing.  Tiny  bits  of  the  tubing 
would  break  off  from  pumping  with  it,  and  they  would  all  go  to  the 
lungs  and  plug  up  the  capillaries  of  the  lungs. 

Hughes:   So  it  was  more  lung  problems  than  heart  problems. 

Gerbode:  Yes.   But  then  there  were  central  nervous  system  problems  too 

because  some  of  that  blood  went  to  the  brain  and  produced  little  capillarj 
thromboses.  A  few  patients  would  have  central  nervous  system  events 


*In  a  letter  to  Bjork,  written  in  1960,  Dr.  Gerbode  said  that  he 
was  using  hypothermia  to  the  level  of  18°  centigrade. 


371 


Gerbode:   which  would  be  kind  of  frightening.   Practically  all  recovered  from 
them,  but  I  think  that  there  was  probably  a  little  more  brain  damage 
than  we  were  able  to  measure. 

I  suppose  the  main  postoperative  problems  were  failure  to 
recover  as  quickly  as  you  expected  the  patient  to.   But  the  main 
thing,  neurological  problems.   The  ones  who  did  revive  right  away 
seemed  a  little  bit  slow  in  recovering  and  some  didn't  recover. 
The  mortality  rate  wasn't  very  high;  I'm  talking  about  isolated 
cases  here  and  there  which  did  not  revive  as  quickly  as  we  expected. 
It  took  us  quite  a  while  to  realize  that  this  wasn't  due  to 
hypothermia  itself;  it  was  due  to  the  fact  that  oxygenators  weren't 
really  taking  care  of  the  damage  to  the  blood  properly.   We  studied 
this  a  bit  later  and  found  out  that  blood  filtration  was  the  best 
preventative  of  serological  manifestations  after  open  heart  surgery. 


An  Aortic  Valve  Prosthesis* 

Hughes:   There  was  another  letter  written  in  1962  on  an  aortic  valve 

prosthesis  which  apparently  you  were  developing  with  Franz-Josef 
Segger.   He  was  training  with  you  at  that  point.   Was  that  an  idea 
that  he  came  to  you  with? 

Gerbode:   No,  that  valve  which  we  were  developing  with  Franz  Segger  was  one 
which  came  out  of  our  own  laboratory.   We  didn't  know  what  to  use 
at  that  time,  of  course,  so  we  investigated  all  the  prosthetic 
material  that  was  available  and  finally  decided  on  one  which  seemed 
to  be  the  most  feasible.   Franz  Segger  and  I,  with  the  help  of  a 
dentist  actually ,  developed  a  stent  on  which  we  could  build  an 
artificial  prosthesis  out  of  synthetic  material.  Unfortunately  it 
was  made  out  of  material  which  was  mostly  silicon  and  this  functioned 
only  for  a  relatively  short  period  of  time.   It  was  the  best  thing 
we  had  at  the  time,  however,  but  it  wasn't  good  enough. 

Hughes:    How  did  it  compare  to  other  aortic  valves? 
Gerbode:   Well,  there  weren't  any,  really. 
Hughes:    I  saw  a  reference  to  a  'Muller. ' 


*The  following  discussion  of  medical  and  surgical  typics  was  moved 
from  the  session  recorded  on  5/3/84. 


372 


Gerbode:   Oh  yes.   Muller  valves  and  also  a  McGoon  valve  were  developed  out 

of  cloth  and  made  into  bicuspid  valves.   I  put  one  of  those  in  once. 
This  was  something  that  would  correct  the  insufficiency  and  the 
stenosis,  but  unfortunately  these  cloth  valves  fell  apart  very 
quickly. 

Hughes:   Was  your  valve  ever  used  on  a  wide  scale? 

Gerbode:  No,  it  wasn't.   We  watched  it  very  carefully  and  when  a  couple  of 
them  failed  because  of  fracture  of  the  cusps,  we  stopped  using 
them  immediately. 

Hughes:   Was  the  design  quite  different  than  that  of  the  other  valves? 

Gerbode:  Yes.  Our  valve  was  based  on  the  same  anatomy,  the  same  appearance, 

of  a  normal  [aortic]  valve.   Their  valves  were  bicuspid  valves, 

which  were  two  flaps  of  cloth  which  opened  and  closed.  Mechanically 
they  worked  all  right  for  a  short  period  of  time. 

Hughes:   Why  did  they  think  of  changing  nature's  design?  The  aortic  valve  is 
not  a  bicuspid  valve,  is  it? 

Gerbode:   No,  it's  a  tricuspid  valve.   It's  easier  to  make  a  bicuspid  valve. 
Hughes:   And  that  was  the  reason. 
Gerbode:  Yes. 

Hughes:   In  1962  Bjork  wrote  to  you  from  Uppsala  saying  that  he  was  very 
impressed  with  your  ability  to  put  in  an  aortic  valve  in  twenty 
minutes.   He  said  that  it  took  him  an  hour.   I  was  wondering  why 
there  was  that  great  difference  in  time. 

Gerbode:   I  don't  know. 
Hughes:   He  was  slow. 

Gerbode:   I  wouldn't  say  that.  Maybe  I  was  fast  and  maybe  he  was  slow,  but 
I  don't  know. 

Hughes:    That  would  make  a  difference  though  in  1962,  wouldn't  it?   I'm 

thinking  of  the  oxygenator  and  the  problems  that  were  still  happening. 


Gerbode:   Yes. 


373 


The  Early  Membrane  Oxygenator 


Hughes:    In  January  1967,  you  wrote  to  Clarence  Crafoord  at  the  Karolinska 
that  Hallikainen  Instruments  of  Richmond  was  producing  a  fully 
engineered  membrane  heart-lung  machine.   I  was  surprised  at  this 
because  I  didn't  realize  that  you  were  marketing  the  membrane  at 
that  stage. 

Gerbode:   We  weren't  marketing  it,  but  they  had  developed  it  and  so  they 
ware  willing  to  make  a  few  for  others  to  try. 

Hughes:    So  it  was  really  a  prototype? 

Gerbode:   Yes. 

Hughes:   What  became  of  it? 

Gerbode:   I  used  it  in  about  three  hundred  patients,  but  the  problem  was  that 
it  was  too  difficult  to  service  between  operations.   Patients  did 
very  well  on  it,  but  there's  a  certain  point  where  if  things  work 
easily  or  don't  work  easily,  you  have  to  decide  whether  to  use  them 
or  not. 

Hughes:    It  was  not  only  the  disk  oxygenator  that  was  sent  over  to  Cutter 
[Laboratories]  to  be  cleaned? 

Gerbode:   The  membrane  had  to  be  sent  over,  [cleaned],  and  assembled  by  Cutter, 
which  was  also  very  difficult,  and  a  nurse  had  to  be  over  there  who 
could  put  these  various  layers  in  the  membrane  together ,  and  usually 
Bram  went  over  to  supervise.   This  was  too  complicated. 

Hughes:   Were  there  other  membranes  at  that  time  used  right  here  in  the 
Bay  Area? 

Gerbode:   There  weren't  any  really  in  use  at  that  time.   We  had  the  first 
membrane  which  was  used  clinically  on  a  broad  scale. 

Hughes:   Were  you  using  the  disk  at  the  same  time? 

Gerbode:   No,  I  don't  think  so.   When  we  switched,  we  used  just  the  membrane. 

Hughes:   When  you  found  that  this  wasn't  feasible,  you  went  back  to  the  disk? 

Gerbode:   When  we  found  the  membrane  was  too  complicated  to  run  routinely  in 
cases,  the  bubble-oxygenators  came  into  being. 

Hughes:   The  chronology  then  was  disk,  membrane,  bubble. 


374 


Hughes:   Later  you  joined  the  Harvey  Corporation.  Why  the  change? 

Gerbode:  We  had  done  a  lot  of  research  on  the  membrane  oxygenator  and 

developed  a  method  of  getting  maximum  oxygenation  and  CC>2  transfer 
of  the  blood.   This  was  incorporated  in  a  new  design  for  a  membrane 
oxygenator.   We  realized  that  we  couldn't  produce  this  on  a  large 
scale,  so  we  asked  the  Harvey  Company  to  come  in  and  take  over  the 
development  of  a  production  model.   It  looked  very  feasible  to  them, 
so  we  gave  them  the  patents  which  we  had  and  let  them  go  ahead  with 
it.  After  about  five  years  of  work  in  their  laboratories  to 
produce  a  commercially  viable  product,  they  decided  to  adopt  the 
Dow  Chemical  membrane  oxygenator  probably  because  they  felt  they 
could  make  more  money  with  it. 

Hughes:   Can  you  summarize  the  differences  between  the  membrane  oxygenator 
at  the  stage  it  was  being  worked  on  by  the  Hallikainen  Company  and 
Harvey? 

Gerbode:   It  had  to  be  put  into  a  package  which  could  be  disposable  after  each 
operation.   The  Hallikainen  was  used  once  and  [then]  it  had  to  be 
taken  apart  and  cleaned  and  put  together  by  an  expert.  All  hand 
work.   The  one  which  Harvey  finally  developed  was  one  which  could 
be  put  together  quickly  and  commercially  in  a  way  which  was 
feasible  as  far  as  general  use  was  concerned.   Unfortunately,  I 
think  they  found  the  Dow  Chemical  one  would  be  cheaper  to  market 
than  ours.  Now  they  are  selling  the  Dow  Chemical  one.  These 
big  companies  keep  looking  for  something  which  will  make  them  more 
money  right  away. 

Hughes:   Do  you  think  that  boils  down  to  ease  of  manufacture? 

Gerbode:   Ease  of  manufacture,  ease  of  assembling,  ease  of  operation.   The 
minor  differences  in  physiology  of  each  one  are  erased  by  all  the 
mechanical  aspects  of  putting  it  together. 

Hughes:   The  changes  that  occurred  between  your  early  membrane  and  the  later 
ones  were  somewhat  in  terms  of  ability  to  clean  them.  Wasn't  that 
a  big  factor?  Did  that  boil  down  to  different  materials  that  were 
available  over  time? 

Gerbode:  Yes,  it  did  in  a  way,  because  originally  we  weren't  using  the  same 

membranes  which  we  used  in  the  end.   In  the  end  microporous  membranes 
came  into  being  and  almost  all  the  companies  that  were  involved  in 
this  business  switched  to  them  because  the  oxygen  and  CC^  transfer 
through  those  membranes  is  so  much  better  than  anything  we  had  before. 
Our  oxygenator  behaved  beautifully  with  these  microporous  membranes. 


375 


Hughes:   Were  those  membranes  developed  specifically  with  this  use  in  mind? 

Gerbode:   No,  they're  used  in  industry  a  lot.   This  development  came  out  of 

industry.   There  are  a  lot  of  other  uses  for  microporous  membranes. 


The  Bubble  Oxygenator 


Hughes:    I  have  a  letter  here  that  you  wrote  to  Hans  Borst  in  1957  and  in  it 
you  referred  to  the  Lillehei  system.   Do  you  want  me  to  read  it? 

Gerbode:   Yes. 

Hughes:   "I  have  your  letter  of  April  10,  1957  and  was  interested  in  your 

remarks  about  the  Lillehei  system.   We  have,  of  course,  experimented 
with  this  device  for  about  a  year  and  a  half  now  and  have  found  it 
to  be  far  from  what  we  would  like  for  human  use  although  I  know  it 
has  been  used  successfully  in  many  cases.   We  have  our  own  combination 
of  Gibbon  pumps,  which  the  Gartner-Kay  model  also  uses,  but  we  have 
disposable  membrane  lungs  made  of  plastic.   This  gets  away  from 
pyrogens  and  problems  with  cleaning  screens,  etc.   Our  extracorporeal 
program  is  booked  solid  until  June.   It  is  curious  that  for  a  while 
we  wondered  whether  there  would  be  much  demand  here  for  this  kind 
of  work,  for  the  demand  far  exceeds  our  ability  to  meet  it  at  the 
moment  and  1  worry  that  my  research  program  may  get  submerged  by 
the  clinical  work.   But  that  is  a  matter  of  interpretation,  for  a 
great  deal  of  clinical  work  can  be  done  on  a  rather  large  volume  of 
cases  which  is  now  going  through  my  service. 

"We  have  also  built  a  small  new  laboratory  for  extracorporeal 
experiments  and  I  have  an  excellent  staff  of  associates  including 
Jack  Osborn  and  a  number  of  others.   I  believe  that  Dennis  Melrose 
is  coming  from  England  to  work  with  us  on  problems  of  physiology 
and  extracorporeal  circulation.   But  I  doubt  if  he  would  be 
interested  in  doing  any  surgery." 

What  was  this  Lillehei  system  that  you  referred  to? 
Gerbode:   It  was  using  the  bubble  oxygenator. 

Hughes:   Which  at  that  point  you  were  realizing  had  drawbacks? 
Gerbode:   Certain  limitations,  yes. 


376 


Hughes:   Was  that  obvious  pretty  quickly  because  in  1957  they  hadn't  been 
around  for  a  long  time. 

Gerbode:  No,  it  wasn't  obvious  right  away,  but  it  was  pretty  soon. 

Hughes:   This  was  the  reason  that  the  bubble  oxygenator,  you  felt,  was 
inadequate  for  patient  use? 

Gerbode:  Well,  it  had  limitations. 

Hughes:  Which  meant  that  you  didn't  use  it. 

Gerbode:  Not  in  the  beginning,  but  later  on  we  did  use  it. 

Hughes:  After  it  had  been  improved  somewhat? 

Gerbode:  Yes,  it  had  been  improved  quite  a  bit. 

Hughes:  What  about  problems  with  bubbles  or  micro-bubbles? 

Gerbode:  And  there  were  bubbles  too.   This  is  true  of  using  bubble  oxygenator s. 
Though  to  a  much  lesser  extent ,  even  the  disk  oxygenator  produced 
bubbles  which  got  through  the  filtration  and  other  systems. 

Hughes:   But  the  bubble  oxygenator  was  worse? 
Gerbode:   It  was  the  worst  and  it  still  is. 

Hughes:   Why  did  you  doubt  that  there  would  be  much  demand  for  the  extracorporeal 
program? 

Gerbode:  You  never  know  what  cardiologists  will  do  and  realizing  how  difficult 
it  was  in  the  beginning  to  start  closed  heart  surgery,  I  didn't 
know  whether  they'd  accept  open  heart  surgery  or  not.   So  I  guess  it 
wasn't  until  the  results  were  good  that  they  realized  that  this 
was  the  best  way  to  take  care  of  these  patients. 

Hughes:   So  there  really  was  doubt  amongst  cardiologists  in  the  beginning 
that  open  heart  surgery  was  an  acceptable  technique? 

Gerbode:   I  don't  know  whether  it  was  doubt.   I  think  it  was  just  hesitancy. 
Hughes:   Turning  over  their  patients  to — 
Gerbode:   ...these  terrible  surgeons! 

Hughes:   Do  you  think  your  research  program  did  get  submerged  by  the  clinical 
work  at  this  time? 


377 


Gerbode:   No,  I  kept  the  laboratory  going  all  the  time. 

Hughes:   When  you  speak  of  the  advantages  of  clinical  work,  you  mean  from 
the  standpoint  of  accumulating  cases  and  statistics? 

Gerbode:   Yes,  and  studying  what  really  happened. 

Hughes:   How  did  you  manage  your  day,  assuming  that  you  had  a  fairly  heavy 
case  load.   Were  there  certain  times  which  you  set  aside  to  work 
in  the  dog  lab? 

Gerbode:   On  certain  days  I  went  over  to  the  dog  lab. 
Hughes:   You  didn't  schedule  cases  on  those  days? 
Gerbode:   That's  right. 


Early  Extracorporeal  Research 


Hughes:   Do  you  remember  when  the  extracorporeal  work  with  Jack  Osborn  began 
in  earnest? 

Gerbode:   Jack  came  with  me  in  the  early  1950s  and  we  started  working  then. 

Jack  came  with  some  experience  with  hypothermia  in  New  York,  not  so 
much  with  heart-lung  machines.   I  told  him  early  on  that  I  thought 
we  ought  to  get  on  with  a  heart-lung  machine.   We  looked  at  various 
ones  which  were  already  on  an  experimental  basis.   One  of  these,  the 
disk  oxygenator,  had  actually  been  worked  on  at  the  Karolinska  by 
Crafoord. 

Hughes:   When  was  this? 

Gerbode:   The  early  fifties.   At  the  same  time  John  Callaghan  came  from  Canada 
and  worked  with  me  in  the  laboratory.   We  tried  various  other  kinds 
of  oxygenator s.   We  used  plastic  bags  filled  with  oxygen  and  mixed 
blood  with  a  sort  of  a  bubble  oxygenator  in  a  plastic  bag.   We  used 
this  experimentally,  a  terribly  cumbersome  way  of  trying  to  do  it. 
We  did  a  couple  of  patients  with  this  method  and  that  wasn't  very 
good  either.   This  was  really  before  the  idea  of  bubbling  oxygen 
through  a  column  of  blood  proved  to  be  feasible. 

Hughes:   Are  you  saying  that  Osborn  came  to  you  with  the  idea  of  working  on 
hypothermia  rather  than  the  heart-lung  machine. 


378 


Gerbode:   He  came  with  the  reputation  of  working  on  some  basic  things  in 
hypothermia. 

Hughes:   Where  had  he  done  his  previous  work? 

Gerbode:  At  New  York  Hospital.  We  really  didn't  exploit  his  previous  work 
in  hypothermia  at  that  time.  We  got  started  trying  to  develop  a 
heart-lung  machine. 

Hughes:  Was  it  easy  to  talk  him  into  working  on  the  heart-lung  machine? 

Gerbode:  Oh  yes. 

Hughes:  It  took  a  number  of  years  to  combine  those  two  processes,  didn't  it? 

Gerbode:  It  did. 

Hughes:  In  retrospect,  it  seems  obvious. 

Gerbode:   I  guess,  what  happened  mostly  was  that  we  could  see  the  need  after 
a  while,  and  we  realized  that  something  was  necessary  to  supply  the 
need,  and  hypothermia  would  not  really  supply  the  need — a  great 
adjunct  to  the  picture,  but  not  an  answer  to  the  whole  picture. 

Hughes:  The  use  of  hypothermia  with  the  oxygenator  took  surprisingly  long. 
That  didn't  occur  right  from  the  beginning,  yet  the  two  techniques 
were  going  on  side-by-side  for  almost  a  decade. 

Gerbode:  We  realized  that  the  hypothermia  would  help  almost  anything  relative 
to  a  heart  operation.   But  we  also  realized  it  would  overcome  some 
of  the  inadequacies  of  an  oxygenator  system. 

Hughes:   Were  there  certain  operations  that  you  were  doing  with  closed  heart 
procedures? 

Gerbode:  Yes.  We  were  doing  closed  heart  procedures  all  the  time. 

Hughes:   After  the  heart-lung  was  available,  were  you  picking  and  choosing 
your  operation  procedure? 

Gerbode:   There  were  certain  cases  we  could  do  with  closed  heart  techniques 

quite  safely  and  quite  easily.   The  ones  that  we  thought  we  could  do 
this  way,  we  did. 

Hughes:   A  letter  from  Hans  Borst  [written  early  in  1958]  has  an  interesting 
passage:   "As  you  know,  Professor  [Rudolph]  Zenker  has  been  in  the 
States.   He  had  hoped  very  much  to  see  you  in  San  Francisco  but 


379 


Hughes:    contracted  grippe  in  Los  Angeles.   His  impression  of  the  United 
States  was  most  interesting  for  me,  as  you  can  imagine.   He  was 
very  much  impressed.   However,  the  basic  differences  between 
American  and  German  medicine  seem  so  remarkable  that  there  doesn't 
really  exist  a  possibility  to  modify  the  present  system.   The 
differences,  he  felt,  are  due  to  the  fact  that  in  the  U.S.  there 
is  a  shortage  of  doctors  and  there  is  private  initiative  in 
medicine.   I  am  sure  that  is  a  very  important  sociological  difference, 
but  I  believe  the  real  discrepancy  is  due  to  the  different  mental 
attitudes  in  the  U.S. .this  overcritical  Anglo-Saxon  overtone,  and 
here  [in  Germany] ,  this  curious  mixture  of  hollow  dogmatism  and 
genius. " 

Gerbode:   He's  a  smart  guy,  Hans. 

Hughes:   It's  a  very  interesting  summary.  You  spent  some  time  in  Germany. 
Would  you  agree  with  his  assessment? 

Gerbode:   Now  it's  much  better,  of  course.   The  systems  are  very  much  more 
alike. 


380 


XI  PACIFIC  MEDICAL  CENTER  AND  ITS  PREDECESSORS 


The  Institutes  of  Medical  Sciences  and  the  Old  Presbyterian 
Hospital 


Hughes:   You  said  earlier  that  John  Osborn,  Henry  Newman,  Arthur  Selzer, 

Fred  Merrill  and  Mrs.  Harley  Stevens  were  the  original  founders  of 
the  Institute  of  Medical  Sciences.  I  know  of  Osborn,  but  why  were 
the  others  involved  and  who  were  they? 

Gerbode:  Well,  Arthur  Selzer  was  our  cardiologist  and  he  was  very  interested 
in  experimental  work  at  the  time  because  there  wasn't  very  much 
clinical  work.   So  I  asked  him  to  join  the  group  to  form  the 
institutes.   Mrs.  Stevens  is  a  very  good  friend  of  mine  and  very 
interested  in  the  research  that  I've  always  done.   She  has  always 
been  very  supportive  and  so  she  came  along  for  that  reason. 

Hughes:   Was  she  putting  money  into  it  as  well? 

Gerbode:   She  put  some  money  into  it.   She  has  sense,  too.   Jack  Osborn  of 
course  came  with  me  to  develop  and  run  the  heart-lung  machine ,  so 
it  was  natural  for  him  to  come  along. 

Hughes:   He  was  already  here  at  Stanford  Hospital? 

Gerbode:   Yes. 

Hughes:   What  about  Fred  Merrill? 

Gerbode:   Fred  Merrill  was  on  the  board  of  trustees  of  the  hospital  and  so  I 
put  him  on  [the  board  of  the  institutes]  because  he  was  a  good 
representative  businessman. 

Hughes:   Did  the  six  of  you  really  establish  the  policy  and  get  the  whole 
thing  going? 

Gerbode:   Yes. 


381 


Gerbode:   When  Stanford  pulled  out,  we  had  no  organization  to  work  through. 

I  took  a  look  at  the  chiefs  of  service  and  decided  that  none  of  them 
were  interested  in  research,  and  it  would  be  impossible  to  get  them 
to  agree  on  anything  relative  to  research,  so  I  just  gave  up  on  that. 
In  fact,  when  we  started  thinking  about  building  the  research 
building  and  wanted  to  take  some  of  the  money  which  a  very  nice  lady 
had  left  us,  and  asked  for  something  like  $150,000,  there  was  a 
great  uproar.   They  said,  "We  need  a  hospital  more  than  a  research 
building.   We've  got  to  put  that  money  into  a  hospital.   We  couldn't 
even  buy  a  dressing  room  for  $150,000!" 

Hughes:  So  how  did  you  handle  that? 

Gerbode:  We  just  went  ahead  and  did  it  anyway. 

Hughes:  Eventually  the  hospital  was  built.   Was  that  very  shortly  thereafter? 

Gerbode:  That's  another  story  when  we  got  that  hospital  built. 

Hughes:  I've  forgotten  how  much  longer  that  took. 

Gerbode:   It  took  seven  or  eight  years  or  more,  I  guess.   There  were  all  kinds 
of  plans  designed  by  various  experts  to  convert  the  old  Stanford 
Hospital  and  the  rest  of  those  buildings  into  a  modern  hospital.   It 
was  just  wasted  time  and  money  to  do  that  and  the  only  ones  who 
profited  by  it  were  the  planners. 

II 

Hughes:   You  talked  earlier  about  the  vigor  of  the  program  in  heart  surgery 
carrying  along  the  hospital  for  a  number  of  years. 

Gerbode:  I  think  there  was  a  time,  when  we  burst  into  the  field  of  heart 
surgery  and  started  doing  a  lot  of  cases ,  when  we  were  the  only 
really  ongoing  unit  in  the  whole  hospital. 

Hughes:   What  happened  to  the  patients  that  had  been  coming  to  Stanford 
Hospital? 

Gerbode:   I  think  some  of  them  didn't  stay  with  us  because  they  were  told  by 
the  Stanford  administration  that  the  hospital  was  going  to  close. 
Some  of  them  even  believed  that.   They  felt  that  with  some  of  the 
faculty  moving  to  Palo  Alto ,  that  the  faculty  who  were  staying 
weren't  good  enough  for  them.   A  lot  of  little  things  like  that. 

Many  times  I  heard  people  say  when  a  patient  was  referred,  "Where 
are  you  going  to  operate  on  this  patient?"   I  said,  "In  the  old 
Stanford  Hospital."  They  would  say,  "We  thought  that  was  closed." 
This  was  deliberately  conceived  by  one  of  the  trustees  of  the  university. 
Absolutely  deliberate. 


382 


Hughes:   Was  it  motivated  by  their  fear  of  competition? 

Gerbode:   Yes.   Stanford  didn't  think  they  could  make  it  too  easily.   They 
even  wanted  to  close  the  out-patient  clinic.   Stanford  said,  "We 
have  no  money  to  pay  a  deficit  for  an  out-patient  clinic."  So  since 
they  raised  the  question  of  the  deficit,  Henry  Gibbons  and  I  got 
fifty  doctors  to  promise  one  thousand  dollars  apiece  to  pay  for  any 
deficit  in  the  out-patient  clinic.   Of  course,  there  wasn't  any 
deficit  and  so  we  didn't  have  to  pay  anything. 

Hughes:   Were  you  pretty  confident  of  that? 

Gerbode:   Oh  sure.   You  see,  it's  a  natural  place  for  a  clinic.   It's  near 

the  underprivileged  people  and  hundreds  of  those  patients  have  been 
coming  there  for  generations,  and  many  of  them  walked  to  the  clinic. 
The  ones  who  had  to  come  from  farther  away  could  all  get  there  on 
general  transportation.   There  were  lots  of  doctors  who  were  not 
going  to  go  to  Palo  Alto  and  they  were  willing  to  stay  there  and 
take  care  of  those  indigent  patients. 

Hughes:   Did  you  have  trouble  filling  in  the  gaps  in  the  staff  in  those  early 
days? 

Gerbode:   No,  there  was  a  good  distribution  always. 
Hughes:   But  you  had  to  take  on  new  people,  didn't  you? 

Gerbode:   We  did,  but  some  of  the  younger  people  didn't  go  down  [to  Stanford] 
with  the  chiefs,  so  then  they  became  chiefs  up  here.   It  was 
delightful  for  them. 

Hughes:   Tell  me  about  the  other  institutes  that  were  founded  in  these  early 
days? 

Gerbode:   The  other  one  that  came  along  very  strongly  was  the  eye  institute 

[the  Smith-Kettlewell  Institute  of  Visual  Sciences]  under  Dr.  Jampolsky. 
There  was  a  time  when  we  thought  that  maybe  some  of  the  other  eye 
doctors  would  not  go  to  Palo  Alto  and  would  stay  and  help  to 
develop  the  eye  institute.   That  old  Stanford  Medical  School  had  a 
terrific  reputation  in  ophthalmology,  going  back  for  two  generations. 
It  was  started  by  two  Swiss  ophthalmologists,  [Adolf]  Barkan  and 
[Dorman]  Pischel,  who  liked  teaching  and  took  their  responsibilities 
of  being  professors  very  seriously.   They  had  children  and  their 
children  became  doctors  and  carried  on  in  the  profession.   They 
carried  on  with  lots  of  clinic  activity  and  continued  to  he  modern. 
So  we've  always  had  a  big  eye  center  there. 


383 


Hughes:   And  Jampolsky  was  part  of  that? 

Gerbode:   He  was  part  of  it.   He  grew  up  under  Barkan  and  so  did  Cleasby. 

A  whole  bunch  of  the  ophthalmologists  stayed  around  and  some  of  them 
developed  practices  downtown;  some  of  them  developed  practices  in 
other  hospitals,  but  most  of  them  continued  to  teach  in  the  old 
Stanford  Hospital. 

Hughes:   Where  did  the  money  come  from  for  the  eye  institute? 

Gerbode:   Originally  there  wasn't  much  money,  but  they  got  federal  research 
grants,  and  then  there  was  a  fellow  by  the  name  of  Clement  Smith 
who  was  both  a  patient  of  Dr.  Jampolsky  and  mine.   He  had  very  poor 
vision  and  very  poor  circulation.   I  was  taking  care  of  his  poor 
circulation  and  Jampolsky  was  taking  care  of  his  poor  vision.   He  had 
no  relatives.   He  made  an  awful  lot  of  money  in  the  offshore  insurance 
business  after  the  war.   He  liked  us.   I  think  Dr.  Jampolsky  worked 
on  him  harder  for  donations  that  I  did,  although  I  put  my  nickel's 
worth  in  whenever  I  could.   One  day  when  his  health  was  really  failing— 
I  knew  him  through  the  Bohemian  Club — he  called  me  up  and  said,  "Frank, 
I'd  like  to  have  you  come  down  and  talk  to  me.   I'm  going  to  die  before 
long."   So  I  went  down.   He  said,  "I'm  going  to  give  Jampolsky  one 
million  dollars  for  his  eye  work  and  I'm  going  to  give  you  one 
million  dollars.'*  I  said,  "What  do  you -want  me  to  use  the  money  for?" 
He  said,  "Whatever  you  want."  Well,  I  found  it  would  be  much  better 
to  have  that  million  dollars  go  into  the  institutes  as  a  whole  to  help 
the  broad  base  of  all  the  various  research  workers.   So  we  put  it 
into  what  was  then  called  the  Institutes  of  Medical  Sciences. 


The  Institutes 


Gerbode:   Then  Jampolsky  founded  his  own  private  institute  and  kept  the  money 

in  it.   Later  on  he  did  the  same  thing  with  a  woman  named  [Catherine] 
Kettlewell  who  was  a  patient  of  his.   Mrs.  Kettlewell  gave  all  her 
money  to  Jampolsky 's  eye  institute. 

Hughes:    The  eye  institute  is  separate  from  the  Institutes  of  Medical  Sciences? 

Gerbode:   They  have  two  foundations  as  I  understand  it.   They  use  all  their  money 
for  cheir  eye  work.   Because  of  Smith  and  Kettlewell,  they  got  enough 
money  to  build  their  own  building. 

Hughes:    So  they're  more  independent  than  the  rest  of  the  institutes? 

Gerbode:   Yes,  they're  independent,  but  they  have  to  use  MRI  as  an  umbrella 
because  they  have  a  certain  number  of  federal  grants  and  they  need 
to  have  the  institute  to  back  them. 


384 


Hughes:   Is  that  the  only  real  reason  that  they  keep  the  affiliation? 

Gerbode:   I  think  so  because  they  don't  really  cross-fertilize  much  in  their 
research. 

H